Urogynecology 林教授
生產常造成 Pubocervical ligament損傷
------------
排尿flask bottle->squat bottle
------------
Forces of Continence
Intrinsic Urethral Mechanism
Mucosa (coaptation)
Submucosa (compression)
Smooth muscle (compression)
Skeletal muscle(compression)
------------
Estrogen deficiency常會伴隨Atrophic vaginitis
用local治療比oral好
Contraindication of estrogen
- breast cancer
- endometrioid cancer
- DVT
------------
Borney Cough test 定性
------------
Definition of Outcome by Pad Test
Cure: less than 1 g
improvement: decrease by more than half of pad weight
Failure
Success = Cure + Improvement
------------
Endoscopic tests: diverticulum tumor
Perineal ultrasound: bladder cancer
------------
Cotton Swab test (Q-tip test)
With cough or Valsalva
UVJ hypermobility
------------
白天單次最大量可當做SD
(早上第ㄧ泡不算)
------------
Diastasis
Diastasis recti (also known as abdominal separation) is commonly defined as a gap of roughly 2.7 cm or greater between the two sides of the rectus abdominis muscle.
------------
Urethral pressure profile (UPP)
n Functional urethral length= 3.6 cm
n MUCP (maximal urethral closure pressure)= 70~90 cm H 2 O
------------
Pressure Transmission Ratio (PTR)
PTR =ΔPure/ΔPves
------------
Low grade Blaivas class 做Burch
------------
Etiology of Urinary Incontinence (UI)
n Bladder-related (urge or reflex incontinence)
n Detrusor overactivity (DO)
n Low bladder compliance
n Bladder oversensitivity
n Sphincter-related (stress incontinence)
n Anatomic incontinence (type I, II USI)
n Intrinsic sphincter damage/dysfunction/disorder (type III USI)
n Outflow obstruction (overflow incontinence)
n Normal bladder and sphincter mechanism (functional incontinence)
------------
Behavioral Techniques
n Bladder training 練習憋尿，但是不要long-term
n Habit training
n Prompted voiding
n Pelvic muscle exercises (Kegel’s exercise)
不要用rectus abdominus
可用EMG監測
n Biofeedback
n Vaginal cone retention
n Electric stimulation買6000元，租一萬五
n Magnetic wave chair
Vaginal Laser 270萬一台, 外面診所有的一次兩萬,有的五千元,
通常要做三次
------------
Surgical Treatment of U.I.
n Bladder neck hypermobility
1. Anterior vaginal repair
2. Retropubic bladder neck suspension
3. Needle bladder neck suspension
n Intrinsic sphincter deficiency (ISD)
1. Sling procedure
2. Placement of an artificial sphincter
3. Periurethral bulking injections 太貴不持久
------------
TVT; tension-free vaginal tape 1 kit US$600
TOT; transobturator tape
吊太多則AUR; acute urine retension
Monarc Mesh Position
------------
Other Measures and
Supportive Devices for LUTD
n Intermittent clean self catheterization (ICSC)
n Indwelling catheter
n Suprapubic catheters
n External collection catheters
n Penile clamps
n Pessaries
n Absorbent pads or garments
------------
沒有留言:
張貼留言
歡迎指教