DETRUSOR EXTERNAL SPHINCTER DYSSYERGIA 逼尿肌外括约肌协同失调.pptVIP

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2018-06-19 发布于福建
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DETRUSOR EXTERNAL SPHINCTER DYSSYERGIA 逼尿肌外括约肌协同失调.ppt

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DETRUSOR EXTERNAL SPHINCTER DYSSYERGIA 逼尿肌外括约肌协同失调

DETRUSOR EXTERNAL SPHINCTER DYSSYNERGIASphincterotomy OR Stent? Saleh A.A.Binsaleh DESD-Background Defined as involuntary external urethral sphincter contractions during involuntary detrusor contractions. These results in a high bladder pressure with subsequent back pressure effects. The rate of urological complications from DESD with no intervention is 50% These include: sepsis,hydronephrosis,VUR,nephrolithiasis,renal insufficiency and even failure. Treatment Options Current treatment options aim to minimize intravesical pressure and its detrimental effect on the upper urinary tract. These includes: 1-Chronic indwelling catheterization. 2-Intermittent self catheterization. 3-Pharmacological therapy. 4-Bladder reconstruction and urinary diversion. Treatment Options (cont.) 5-External sphincterotomy. 6-Urolume stent. 7-Sphincter ablation with Botulinum toxin inj. 8-Intrathecal continous baclofen infusion. 9-Balloon dilatation. 10-Laser sphincter ablation. External Sphincterotomy A surgical incision into the sphincter muscle to open it, then urine drains out and collected by condom drainage. Unfortunately,the female anatomy does not allow for condom drainage as an alternative. Usually requires a few days of hospital admission. External Sphincterotomy (cont.) Complications include: 1- Reoperation in 12-26% of cases. 2- Hemorrhage requiring transfusion in 5-23% of cases. 3- Erectile dysfunction (complete or partial) in 3-64% of cases. 4- Irreversible. The Urolume It is a metal flexible mesh prosthesis, that is inserted into the urethra and placed over the external sphincter, holding it open with a constant force. Over a few months, a layer of tissue grows over the wall of the Urolume making a smooth, open passageway to allow urine to pass freely. Large lumen(42F) allowing. Can be done as an outpatient bases. Minimal bleeding over 2-3 days. The Urolume (cont.) Potentially reversible. 10 % rejection rate. (uncovered Urolume need to be removed). Stenosis in 3%. Best