《间质性膀胱炎和下尿路综合征进展优秀PPT.ppt》由会员分享，可在线阅读，更多相关《间质性膀胱炎和下尿路综合征进展优秀PPT.ppt（54页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、间质性膀胱炎和下尿路综合征进展第一页，本课件共有54页There are five entities of lower urinary tract dysfunction(LUTD)underlined together for establishing clinical practice guidelines 1.LUTS/BPH2.overactive bladder(OAB)3.stress urinary incontinence/pelvic floor prolapse(SUI/POP)4.interstitial cystitis(IC)5.geriatric incontine
2、nce (GI)第二页，本课件共有54页SupplementAccording to the following description,two entities should be added into LUTD,i.e.6.detrusor underactivity(DN)7.sphincter overactivity(SO),formerly dysfunctional voiding(DV)第三页，本课件共有54页IC and LUTDAmong the five entities,functional disorder dominated in OAB,SUI,and GI,pa
3、thological or mechanical factors may dominate in BPH and IC.Functional disorder may also result from BPH and IC.We should always take attention to organic as well as functional elements in the diagnosis and treatment of LUTD.第四页，本课件共有54页IC and LUTDFunctional classification is very important to neuro
4、genic or non-neurogenic LUTD.EAU lanched a classification system 2008 and proposed it for clinical practice.And we think its principle suited to non-neurogenic LUTD too.第五页，本课件共有54页第六页，本课件共有54页第七页，本课件共有54页The last two ones were marked as“sphincter only”,meaning the original lesion is subtle or unkno
5、wn.Sphincter overactivity or underactivity in non-neurogenic LUTD,i.e.,dysfunctional voiding(DV)or intrinsic sphincter deficiency（ISD）,have the same meaning.第八页，本课件共有54页Old standard for interstitial cystitis(1988)第九页，本课件共有54页New name(PBS/IC）and its definition(confirmed in May 2007).PBS/IC would be d
6、iagnosed on the basis of PBS/IC would be diagnosed on the basis of chronic pelvic chronic pelvic painpain,pressure or discomfort perceived to be related to,pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other the urinary bladder accompanied by at le
7、ast one other urinary symptoms like urinary symptoms like persistent urge topersistent urge tovoid or urinary frequencyvoid or urinary frequency.Confusable diseases as the.Confusable diseases as the cause of the symptoms must be excluded.Further cause of the symptoms must be excluded.Further documen
8、tation and classification of PBS/IC might be documentation and classification of PBS/IC might be performed according to findings at performed according to findings at cystoscopy with cystoscopy with hydrodistentionhydrodistention and morphological findings in bladder and morphological findings in bl
9、adder biopsies.biopsies.第十页，本课件共有54页Changes of name and meaning 第十一页，本课件共有54页Diagnosis method The potassium chloride test,an intravesical challenge comparing the sensory nerve provocative ability of saline versus potassium chloride using a 0.4M-KCl solution,has not gained acceptance as a diagnostic
10、test for a variety of reasons.第十二页，本课件共有54页Diagnosis method As the new century dawned,there was much confusion as to how to define this 100-year-old syndrome,and the need for a clinically useful,universally accepted way to characterize IC took to the forefront.第十三页，本课件共有54页IC and LUTDIC is a diagnos
11、is of exclusion,but exclusion of OAB is usually difficult to do.On one hand,because almost 60%of the patients regarded by experienced clinicians as suffering from IC/PBS failed to meet the criteria,so it is likely that the prevalence of IC/PBS is much higher than traditionally believed.第十四页，本课件共有54页
12、IC and LUTDOn the other hand,some patients traditionally believed as IC may be or may be associated with OAB or DV.DV is a non-neurogenic sphincter overactivity(SO),in some way like detrusor-external sphincter dyssynergia in neurogenic patients.第十五页，本课件共有54页IC and LUTD In the following urodynamics,o
13、ur equipment was Urovision Janus V,from Life-tech International,Stafford,TX,77477-3995,USA.Fax:281-491-6600 E-mail:http:/www.life- 第十六页，本课件共有54页IC,dysfunctional voiding and LUTD DV or SO had better to be confirmed by EMG and pressure-flow study.Although it says nothing about the storage phase in chi
14、ldren,adult patients with DV usually complained of urinary frequency and urgency.第十七页，本课件共有54页When patients pass urine,the detrusor contracts and the sphincter should relax.第十八页，本课件共有54页When patients pass urine,the detrusor contracts and the sphincter should relax.第十九页，本课件共有54页But in patients with D
15、V,both detrusor and But in patients with DV,both detrusor and sphincter contract together.sphincter contract together.第二十页，本课件共有54页But in patients with DV,both detrusor and sphincter contract But in patients with DV,both detrusor and sphincter contract together,in this one she had detrusor underacti
16、vity too.together,in this one she had detrusor underactivity too.第二十一页，本课件共有54页But in patients with DV,both detrusor and sphincter contract together，even in SUI even in SUI patients.patients.第二十二页，本课件共有54页Mechanism related to DV第二十三页，本课件共有54页Effective treatment of DV by GABA-ergic agonistExcitement
17、of the GABA-ergic(such as baclofen)interneuron in the sacral spine by this transmitter induces relaxation of the external sphincter by way of efferent nerve fibrae of the pudendal nerve.第二十四页，本课件共有54页Effective treatment of DV by GABA-ergic agonistWe have made a crossover trial to compare baclofen an
18、d control.（BJU Iinternational 2007,100:588592,and Nature Clinicalpracticeurology 2007,4：580).The result was a good news for patients suffered from DV:Treatment with baclofen improves dysfunctional voiding in women.第二十五页，本课件共有54页第二十六页，本课件共有54页第二十七页，本课件共有54页第二十八页，本课件共有54页The randomized crossover study
19、 design第二十九页，本课件共有54页A new urodynamic varible used in the evaluation of extent of harmony between detrusor and sphincterTo compare the extent of DV,the logarithmof the ratio of the electric potentials betweenbefore voiding and at Qmax was used and named as TL value.T:tense,L:loose.TL value=lg(Potent
20、ials before voiding/at Qmax)第三十页，本课件共有54页A new urodynamic varible:TL value The value should be positive in normal subjects with no DV and negative in subjects with DV,increasing when the DV improves or recovers to normal.第三十一页，本课件共有54页A right and precise way to ingest the EMG signals of the anal sph
21、incter Here EMG signals were ingested by transdermal perineal needle-guided wire electrodes,not by skin patch or concentric needle.It has been confirmed the good results and high sensitiveness in distinguishing dyssynergia(overactive)from synergia(normalactive)from more than 5000 cases we have perfo
22、rmed so far.第三十二页，本课件共有54页Baclofen improves dysfunctional voiding in womenThere were significantly fewer voids/24 h and a higher TL value in patients treated with baclofen than in those with placebo.Other variables that significantly improved with baclofen over placebo included increased Qmax and de
23、creased PdetQmax.第三十三页，本课件共有54页Baclofen improves dysfunctional voiding in women Baclofen at a dose of 10 mg,3/d,is an effective and well-tolerated treatment option for patients who have DV.Baclofen decreases frequency and PdetQmax,and increases Qmax and TL value.第三十四页，本课件共有54页Urodynamic investigatio
24、ns of a 55-year-old women Urodynamic investigations of a 55-year-old women with DV and a TL of 1.4,who complained of urinary with DV and a TL of 1.4,who complained of urinary frequency for 11 yearsfrequency for 11 years第三十五页，本课件共有54页Her symptom improved significantly in the urodynamics,Her symptom i
25、mproved significantly in the urodynamics,with a TL of 0.92,after 4 weeks ofwith a TL of 0.92,after 4 weeks oftreatment with baclofen.treatment with baclofen.第三十六页，本课件共有54页During UDS,we must make patients pass urine in sitting position,so position change is necessary.第三十七页，本课件共有54页During UDS,we must
26、make patients pass urine in sitting position第三十八页，本课件共有54页This women pass urine in sitting position and showed DV.第三十九页，本课件共有54页To women proposed as to be IC,the three therapies To women proposed as to be IC,the three therapies have the following meaning.have the following meaning.“Criteria for the
27、diagnosis of interstitial cystitis:E.Symptoms not significantly relieved by antimicrobial agents,anticholinergic drugs,or antispasmodics.”In another words,urinary tract infection,overactive bladder,dysfunctional voiding should be ruled out carefully,if comprehensive urodynamics is not available.第四十页
28、，本课件共有54页Roadmaps of interstitial cystitis and other lower urinary tract dysfunctionFrequency,urgency,and pain Frequency,urgency,and pain Urinary analysisUrinary analysisAntimicrobial agentsAntimicrobial agentsPositive NegativeAnticholinergicsAnticholinergicsUrodynamicsUrodynamicsUneffective OABOABD
29、V or SODV or SOAntispasmodics(baclofen)Antispasmodics(baclofen)Cystoscopy and hydrodistentionCystoscopy and hydrodistentionUneffectiveUneffective第四十一页，本课件共有54页Roadmaps of interstitial cystitis and other lower urinary tract dysfunction Three main elements in diagnosis of IC are pain,frequency and pos
30、itive finding of cystoscope with hydrodistention.At least two of them available are necessary to address IC.In our clinics,urodynamics was the first option for women suffering from frequency and urgency and pain with a negative urinalysis.第四十二页，本课件共有54页Treatment options for ICCurrent treatment modal
31、ities include:dietary control bladder retraining oral medication intravesical therapy hydrodistention neuromodulation surgical intervention psychological support 第四十三页，本课件共有54页Treatment options for ICDietary control:acidic foods,caffeine,alcohol,artificial sweetener and chocolate are common offendin
32、g elements.第四十四页，本课件共有54页Treatment options for ICBladder retraining:A protocol of progressive small increments in voiding time intervals第四十五页，本课件共有54页Treatment options for IC Oral medication:antidepressants,antihistamines(cimetidine,hydroxyzine)pentosan polysulfate(elmiron)sedatives and analgesics 第
33、四十六页，本课件共有54页Treatment options for IC Intravesical therapy:DMSO heparin sulfate hyaluronic acid BCG capsaicin,RTX 第四十七页，本课件共有54页Treatment options for ICHydrodistentionNeuromodulation第四十八页，本课件共有54页Treatment options for ICSurgical interventionPsychological support第四十九页，本课件共有54页Treatment options for IC
34、The treatment for IC is largely empiric.Before the etiologic,diagnostic and therapeutic puzzles can be solved,diagnostic awareness,realistic treatment expectation and psychological support for the patients are the keys to effective management at this point of time.第五十页，本课件共有54页Next steps worldwide E
35、fforts to establish a consensus for a clinical definition,nomenclature,and diagnostic algorithm through the auspices of the AUA and the EAU are underway.第五十一页，本课件共有54页Next steps worldwide It is hoped that these efforts will be somehow linked to provide a conclusion satisfactory to all stakeholders,a
36、nd which is consistent worldwide.第五十二页，本课件共有54页Next steps worldwide The efforts worthwhile focus on how best to proceed with clinical research studies based on the paradigm so that the field can advance for the benefit of all patients.第五十三页，本课件共有54页The endThank you very much for attendance of the conference.同仁勤奋疗顽疾，同仁勤奋疗顽疾，晨星历练兴中华。晨星历练兴中华。余热尚存当自勉，余热尚存当自勉，莫叹巷柏夕阳斜。莫叹巷柏夕阳斜。第五十四页，本课件共有54页