Neurourology Panele

Sakineh Hajebrahimi

Associate Professor of Urology

TUMS

Case#1

• A 45 years old housewife lady G:3 P:3• Urgency, Failur to emptying, low flow

urination , Nacturia and chronic pelvic pain, constepation

• BMI<28• No smoking• No history of neurological diseases• No pelvic floor surgery

Case#1

• Vaginal exam: no hypermobility, no atrophy, cystocele grade:I and no recto or uterine prolaps

• Recurrent UTI• Voiding Diary no polyuria• Ultrasound: bilateral hydronephrosis with

PVR:245• BUN:32, Cr:1.5

Obstructive Uropathy due to Chronic Bladder Distension

Cystoscopic Findings

Dysfunctional voiding in a woman

• What is the next option?

Appearance of Bladder neck after TUI-Bladder neck

Video Urodynamic results before and after TUI-Bladder neck

Case#2

65 year old Housewife

Disabling symptoms of Urinary Urgency, Urge Incontinence and failed to empting, severe

constipation

Infections some times

Multiple Cystoscopies

URODYNAMICS ADVISED

CMG

Case#3

• 24 years old single woman with periodical acute urinary retention

• Normal sono• Normal IVU• Recurrent vaginitis( candidiasis)

Case-4

•A 60 years old man with a history of TUR-P, 2 weeks ago•Urinary retention after surgery and urethral cath for a week•Failure to empting, hesitency, low flow,

Post-prostatectomy Low Detrusor Contractility

Poor bladder compliance and low contractility after prostatectomy

Case Study Case Study

► How should this patient be evaluated? How should this patient be evaluated?

► What treatment options should be offered?What treatment options should be offered?

A 39-year old woman with history of MS from 2 years ago, and takes medications. She reports wetting her underwear small amounts and has urg to go.

She denies nocturia, but some times feels an incomplete voiding

Case Study #4Case Study #4

A 71-year old male with symptoms of mild cognitive impairment (MMS A 71-year old male with symptoms of mild cognitive impairment (MMS exam) reports leaking variable amounts of urine on his underwear 4-5 exam) reports leaking variable amounts of urine on his underwear 4-5 times a day. He also reports nocturia, requiring 3 trips to the bathroom times a day. He also reports nocturia, requiring 3 trips to the bathroom each night to void. each night to void.

His prostate exam shows minimal diffuse enlargement, but no nodules. His prostate exam shows minimal diffuse enlargement, but no nodules. His urinalysis is normal. His urinalysis is normal.

The patient is started on an anticholinergic agent for OAB. The patient is started on an anticholinergic agent for OAB.

The patient returns in follow up two weeks later and reports that the The patient returns in follow up two weeks later and reports that the number of accidents has decreased but the severity of urinary loss number of accidents has decreased but the severity of urinary loss remains the same. remains the same.

He is accompanied by his wife who reports that her husband has He is accompanied by his wife who reports that her husband has increased confusion, and sometimes forgets that he has eaten a meal. increased confusion, and sometimes forgets that he has eaten a meal. He has had recent problems with ambulation.He has had recent problems with ambulation.

Case Study #4 (cont)Case Study #4 (cont)

► What is the strategy at this point? What is the strategy at this point?

► Refer patient for evaluation of dementia?Refer patient for evaluation of dementia?

► Refer patient for urodynamic study?Refer patient for urodynamic study?

► Start anti-cholinergic agent for OAB management? Start anti-cholinergic agent for OAB management?

Case#6

A 25 years old man with history of falling and urinary retention

EMG

DESD type1

DESD type2

EMG

DESD type3B-C reflex

• A 32 years old man with history of SCI at level of T10-12

• Paraplegic• Urinary and fecal incontinence• OAB DSD in UDS • Recurrent UTI• Antichlinergics and CIC• Still wet• Still fecal incontinence