间质性膀胱炎和下尿路综合征进展课件.pptVIP

Roadmaps of interstitial cystitis and other lower urinary tract dysfunction CY Qu Dept Urology, Changzheng Hospital, SMMU qu_cy@ There are five entities of lower urinary tract dysfunction (LUTD) underlined together for establishing clinical practice guidelines 1. LUTS/BPH 2. overactive bladder (OAB) 3. stress urinary incontinence/pelvic floor prolapse (SUI/POP) 4. interstitial cystitis (IC) 5. geriatric incontinence (GI) Supplement According 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) IC and LUTD Among the five entities, functional disorder dominated in OAB, SUI, and GI, pathological 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. IC and LUTD Functional classification is very important to neurogenic 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. The last two ones were marked as “sphincter only”, meaning the original lesion is subtle or unknown. Sphincter overactivity or underactivity in non-neurogenic LUTD, i.e., dysfunctional voiding (DV) or intrinsic sphincter deficiency （ISD）, have the same meaning. Old standard for interstitial cystitis (1988) New name (PBS/IC）and its definition (confirmed in May 2007). Changes of name and meaning 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 test for a variety of reasons. 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 us