This document presents a review of potential pathophysiological phenotypes of overactive bladder (OAB) in an effort to move towards a more personalized treatment approach. It discusses evidence for various hypotheses such as OAB originating from the detrusor, urothelium, urethra, brain, or being associated with factors like metabolic syndrome or sex hormone deficiency. A "prism" diagnostic approach is proposed to identify phenotypes through history, exams, urodynamics and future tests. The goal is to match treatments to patients' characteristics rather than solely considering invasiveness or cost. Limitations around evidence levels and standardized definitions are noted.
This document discusses neurogenic bladder, which occurs when bladder control is affected by damage to the brain, spinal cord, or nerves that control the bladder. It covers the anatomy and physiology of normal bladder function, classifications of neurogenic bladder types based on the location of injury, symptoms, diagnosis through history, exam, and bladder diary, and management approaches including conservative options like timed voiding, drugs, and catheterization as well as surgical options. The primary aims of treatment are protecting the kidneys, achieving continence, restoring bladder function, and improving quality of life.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
OCD is characterized by obsessions and compulsions that affect around 2-3% of the population. Neuroimaging and neuropsychological studies have found abnormalities in brain circuits involved in cognition, motivation, and behavioral control, particularly the frontal-subcortical circuits, in patients with OCD. Specifically, studies have found reduced volumes in regions like the orbitofrontal cortex and anterior cingulate cortex, as well as metabolic and blood flow abnormalities in areas like the caudate, thalamus, and prefrontal cortex. These brain abnormalities may underlie the cognitive and executive function deficits commonly observed in OCD.
This document discusses neurogenic lower urinary tract dysfunction. It begins with an introduction and overview of classifications, causes, evaluation, and specific neurological disorders related to lower urinary tract dysfunction. Evaluation involves taking a thorough history, physical exam, bladder diary, lab tests including urine analysis and post-void residual, and urodynamic studies to assess storage and voiding functions. Lesions in different areas of the nervous system can result in distinct patterns of bladder dysfunction, with suprapontine lesions commonly causing storage issues and infrasacral lesions more often resulting in voiding problems. Treatment aims to protect the upper urinary tract and improve symptoms.
Benign prostatic enlargement (BPE) is a common condition among aging men that can cause lower urinary tract symptoms (LUTS). The document discusses the epidemiology, pathophysiology, differential diagnosis, evaluation, and management of BPE. Key points include that BPE is caused by both aging and androgens, and its prevalence increases significantly with age. The diagnostic evaluation of BPE involves taking a patient history, physical exam including digital rectal exam, urinalysis, prostate-specific antigen level, renal function tests, and uroflowmetry to evaluate urine flow. BPE can cause obstructive or irritative voiding symptoms and complications like urinary retention if not properly managed.
This document discusses Dr. Santosh Agrawal's background and credentials as a urologist and kidney transplant surgeon. It then provides information on overactive bladder (OAB), including definitions, prevalence statistics, quality of life impacts, incidence being underreported, and OAB classification systems. Diagnosis of OAB is discussed, covering patient history, physical exam, lab tests, bladder diaries, and urodynamics. Conservative management options like behavioral modification, bladder training, pelvic floor muscle therapy, and pharmacologic therapies are summarized. Specific drugs for treating detrusor overactivity like tolterodine are also mentioned.
This document provides tips for using a PowerPoint presentation on neurogenic bladder. It recommends:
1. Allowing free downloading and editing of the slides.
2. Noting that half the slides are blank except for the title to facilitate active learning sessions where students provide information before each topic slide is shown.
3. Conducting active learning sessions by first showing a blank slide, asking students what they know about the topic, then showing the content slide. This should be repeated for revisions.
4. The presentation can also be used for self-study by viewing blank slides and thinking about the topic before reading the content slides.
This document discusses neurogenic bladder, which occurs when bladder control is affected by damage to the brain, spinal cord, or nerves that control the bladder. It covers the anatomy and physiology of normal bladder function, classifications of neurogenic bladder types based on the location of injury, symptoms, diagnosis through history, exam, and bladder diary, and management approaches including conservative options like timed voiding, drugs, and catheterization as well as surgical options. The primary aims of treatment are protecting the kidneys, achieving continence, restoring bladder function, and improving quality of life.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
This document provides an overview of overactive bladder (OAB). It defines OAB and its main symptoms of urgency, frequency, and nocturia. It discusses the prevalence of OAB increasing with age and being similar between genders. The document outlines the bladder anatomy and physiology, as well as theories around the etiology and pathophysiology of OAB. It describes the diagnosis and clinical evaluation of OAB through medical history, physical exam, urinalysis, and other tests. Finally, it covers treatment approaches for OAB including behavioral modifications, medications, injections, and surgeries.
OCD is characterized by obsessions and compulsions that affect around 2-3% of the population. Neuroimaging and neuropsychological studies have found abnormalities in brain circuits involved in cognition, motivation, and behavioral control, particularly the frontal-subcortical circuits, in patients with OCD. Specifically, studies have found reduced volumes in regions like the orbitofrontal cortex and anterior cingulate cortex, as well as metabolic and blood flow abnormalities in areas like the caudate, thalamus, and prefrontal cortex. These brain abnormalities may underlie the cognitive and executive function deficits commonly observed in OCD.
This document discusses neurogenic lower urinary tract dysfunction. It begins with an introduction and overview of classifications, causes, evaluation, and specific neurological disorders related to lower urinary tract dysfunction. Evaluation involves taking a thorough history, physical exam, bladder diary, lab tests including urine analysis and post-void residual, and urodynamic studies to assess storage and voiding functions. Lesions in different areas of the nervous system can result in distinct patterns of bladder dysfunction, with suprapontine lesions commonly causing storage issues and infrasacral lesions more often resulting in voiding problems. Treatment aims to protect the upper urinary tract and improve symptoms.
Benign prostatic enlargement (BPE) is a common condition among aging men that can cause lower urinary tract symptoms (LUTS). The document discusses the epidemiology, pathophysiology, differential diagnosis, evaluation, and management of BPE. Key points include that BPE is caused by both aging and androgens, and its prevalence increases significantly with age. The diagnostic evaluation of BPE involves taking a patient history, physical exam including digital rectal exam, urinalysis, prostate-specific antigen level, renal function tests, and uroflowmetry to evaluate urine flow. BPE can cause obstructive or irritative voiding symptoms and complications like urinary retention if not properly managed.
This document discusses Dr. Santosh Agrawal's background and credentials as a urologist and kidney transplant surgeon. It then provides information on overactive bladder (OAB), including definitions, prevalence statistics, quality of life impacts, incidence being underreported, and OAB classification systems. Diagnosis of OAB is discussed, covering patient history, physical exam, lab tests, bladder diaries, and urodynamics. Conservative management options like behavioral modification, bladder training, pelvic floor muscle therapy, and pharmacologic therapies are summarized. Specific drugs for treating detrusor overactivity like tolterodine are also mentioned.
This document provides tips for using a PowerPoint presentation on neurogenic bladder. It recommends:
1. Allowing free downloading and editing of the slides.
2. Noting that half the slides are blank except for the title to facilitate active learning sessions where students provide information before each topic slide is shown.
3. Conducting active learning sessions by first showing a blank slide, asking students what they know about the topic, then showing the content slide. This should be repeated for revisions.
4. The presentation can also be used for self-study by viewing blank slides and thinking about the topic before reading the content slides.
Neuro Urology...Fantastic presentation by Prof Drake of Southmeadmeducationdotnet
- The document discusses the initial assessment and management of neurogenic urinary incontinence. It covers taking a detailed history, performing a neurological examination, investigating with urinalysis and urodynamics, and classifying the neurological lesion. Special considerations for safety include assessing for detrusor sphincter dyssynergia, poor bladder compliance, autonomic dysreflexia, and latex allergies before managing symptoms. Urodynamics helps evaluate the bladder and sphincter function to guide appropriate treatment and ensure renal safety.
This document describes the case of a 21-year-old female presenting with urinary retention symptoms for 2 years. Examinations and investigations revealed normal anatomy but inability to void urine. This is diagnosed as Fowler's syndrome, a condition characterized by involuntary contraction of the urethral sphincter muscle preventing relaxation and voiding. Treatment involves self-catheterization or sacral nerve stimulation to modulate the sphincter and restore voiding. The condition is thought to be due to abnormal nerve signaling between the bladder and sphincter muscles.
This document provides information on benign prostatic hyperplasia (BPH):
- It describes the anatomy and zones of the prostate gland and discusses theories on the causes of BPH related to hormone levels and aging.
- The pathology, clinical features, investigations, management options including medications, minimally invasive procedures, and surgeries for BPH are summarized. Surgical options include transurethral resection of the prostate (TURP) and newer laser procedures.
- Complications of treatments like TURP are noted. Indications for medical versus surgical management are provided.
- The document discusses neurogenic bladder and its management. It provides an introduction to bladder anatomy and function and describes different types of neurogenic bladder caused by conditions such as myelomeningocele, occult spinal dysraphism, sacral agenesis, cerebral palsy, and traumatic spinal injuries. It also discusses evaluation, including history, physical exam, radiographic assessment, and urodynamics. The goals and methods of neurogenic bladder management in children are to preserve the upper urinary tract and improve quality of life through techniques such as clean intermittent catheterization.
This document provides an overview of benign prostatic hyperplasia (BPH). It defines key terms related to BPH and lower urinary tract symptoms. It describes the histopathology and molecular etiology of BPH, risk factors such as aging and genetics, and the pathophysiology whereby BPH causes bladder outlet obstruction and changes in bladder function. It also discusses complications of BPH, correlations with severity measures, and a staging system for determining appropriate treatment.
This document provides an overview of fecal incontinence, including its:
1) Functional anatomy of the rectum and anal sphincter complex
2) Physiology of defecation and the rectoanal inhibitory reflex
3) Causes and risk factors such as aging, neurological diseases, and pelvic floor dysfunction
4) Evaluations including anorectal manometry and endoanal ultrasound
5) Treatments including diet, bowel training, biofeedback, plugs, and medications to reduce stool volume
This document discusses overactive bladder (OAB). It defines OAB as a clinical syndrome of urgency, usually with frequency and nocturia. It can occur with or without urge incontinence. The prevalence of OAB increases with age and it affects both men and women. Treatment progresses from behavioral modifications and oral medications to minimally invasive procedures like botulinum toxin injections or sacral nerve stimulation for refractory cases. More invasive treatments like augmentation cystoplasty or urinary diversion are reserved for cases that fail less invasive options.
JOURNAL about long term lithium treatments in elderly patients with mild cogn...anintamelie
The document describes a randomized clinical trial that investigated the effects of long-term low-dose lithium treatment in older adults with amnestic mild cognitive impairment. 61 participants were randomly assigned to receive either lithium or placebo treatment for 2 years, followed by a 2-year extension phase without blinding. The primary outcomes were changes in cognitive and functional scores after 2 years. Secondary outcomes included neuropsychological tests, CSF biomarkers, and conversion to dementia. Results showed that the lithium and placebo groups were similar at baseline on sociodemographic, clinical, and biological measures.
Parkinson's disease is a brain disorder that progressively affects a person’s ability to control body movements, caused by a disorder of certain nerve cells in a part of the brain that produces dopamine, a chemical messenger the brain uses to help direct and control body movement.
Early diagnosis of Parkinson's disease gives you the best chance of a longer, healthier life. This presentation covers the information about biomarkers for Parkinson Diseases which include biological, physiological and imagine candidate / novel biomarkers.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
This document provides an introduction to the integrative medical approach of Endobiogeny. It discusses the objectives and components of Endobiogeny, which include a detailed patient history, physical exam, classical labs/imaging, and Biology of Functions assessment to evaluate the qualitative and quantitative state of the human organism. Endobiogeny aims to understand disease and health through an integrated analysis of physiological and endocrine relationships and functions. The document provides examples of how Endobiogeny analyzes clinical conditions like Polycystic Ovarian Syndrome through this integrative lens.
This document discusses neurogenic bladder and its management. It begins by outlining the physiology of normal bladder control and describes various types of neurogenic bladder dysfunction that can occur depending on the level of spinal cord or brain injury, including detrusor hyperreflexia, detrusor sphincter dyssynergia, and detrusor areflexia. Diagnostic investigations and treatments are then discussed, including medications, catheterization, neuromodulation, and surgeries. The goal of treatment is to balance bladder emptying and continence for each type of neurogenic bladder dysfunction.
This document provides an overview of multiple sclerosis (MS). It defines MS as an immune-mediated progressive demyelinating disease of the central nervous system. The causes include autoimmune activity and genetic predisposition. In MS, sensitized T cells cross the blood-brain barrier and remain in the central nervous system, promoting damage. Clinical manifestations include fatigue, weakness, numbness, vision problems, and pain. Diagnosis involves MRI, cerebrospinal fluid analysis, and other tests. Treatment includes medications like corticosteroids, mitoxantrone, and amantadine to manage symptoms and slow progression. Nursing care focuses on assessing neurological function and managing issues like incontinence, speech and swallowing difficulties.
Practical bowel management in MS - Maureen CoggraveMS Trust
Aims:
- Understand concept of neurogenic bowel dysfunction (NBD) as seen in people with MS
- Appreciate impact of NBD on quality of life
- Understand the importance of case finding
- Be aware of assessment methods in NBD
- Be aware of potential methods of management, particularly conservative interventions
- Be aware of resources to support management
Descending perineum syndrome (DPS) is characterized by the ballooning of the perineum below the pelvis during straining. It is caused by excessive straining during bowel movements which impairs pelvic floor muscle tone over time. This leads to a descent of the pelvic floor and symptoms like obstructed defecation and eventually fecal incontinence. DPS involves the anterior, middle, and posterior pelvic areas in women. Accurate diagnosis requires examination, imaging, and functional tests to evaluate DPS stage and severity. Treatment may involve biofeedback, pelvic floor exercises or surgery depending on symptoms, stage and response to conservative therapies.
Polycystic kidney disease (PKD) is a genetic disorder that causes fluid-filled sacs, called cysts, to form in the kidneys. These cysts can grow over time and interfere with the kidney's ability to function properly. PKD can lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD), which may require dialysis or a kidney transplant.
There are two types of PKD: autosomal dominant PKD (ADPKD) and autosomal recessive PKD (ARPKD). ADPKD is the most common form and usually develops in adulthood, while ARPKD is a rarer form that usually develops in infancy or childhood.
Symptoms of PKD can include high blood pressure, back or abdominal pain, headaches, urinary tract infections, and blood in the urine. However, many people with PKD may not experience symptoms until later stages of the disease.
There is no cure for PKD, but treatment options can help manage symptoms and slow the progression of the disease. These may include blood pressure medication, pain management, antibiotics for infections, and lifestyle changes such as a healthy diet and exercise. In some cases, surgery may be necessary to remove a large cyst or to transplant a new kidney.
Etiology and neurobiology of obsessive compulsive disorderSimranSandhu673667
This document provides an overview of the etiology and neurobiology of obsessive-compulsive disorder (OCD). It discusses the key topics of diagnosis, neurobiological theories, psychodynamic theories, learning-based theories, cognitive theories, and summary. The neurobiology section outlines the neuroanatomy of OCD including brain regions like the anterior cingulate cortex, orbitofrontal cortex, basal ganglia, and cortico-striatal-thalamic circuits. It also discusses the neurochemistry involving serotonin, dopamine, and glutamate. Neuroimaging findings from MRI, fMRI, and DTI studies are summarized as well. Finally, psychodynamic theories involving Freud's psychosexual stages of development and the case
1. The document discusses the preoperative assessment and management of BPH-associated incontinence, which can include urge, overflow, and post-prostatectomy incontinence.
2. A thorough preoperative evaluation is important to identify contributing factors and assess sphincter function, as TURP can impact continence.
3. Evaluations include history, exams, tests like PVR and urodynamics to determine the type of incontinence and guide treatment selection. Precise tests like multichannel urodynamics are most informative.
PUJO is a restriction of urine flow from the renal pelvis to the ureter that can lead to renal deterioration if left uncorrected. It is a common cause of antenatally detected hydronephrosis, found in around 50% of cases. Obstruction causes progressive changes including renal pelvic and calyceal dilation, thinning of the renal cortex, interstitial fibrosis, and loss of renal function over time. Diagnosis involves renal ultrasound, voiding cystourethrogram, and diuretic renal scintigraphy to evaluate anatomy and function.
1. Testicular cancer is most common in young men aged 20-40 years and accounts for 1% of all cancers in men.
2. Survival rates have improved in the last 15-20 years due to better understanding of the disease, reliable tumor markers, cisplatin-based chemotherapy, and modified surgical techniques.
3. Germ cell tumors make up 90-95% of testicular cancers and have predictable patterns of local and lymphatic spread that aid in staging and treatment.
Renal cell carcinoma (RCC) is a cancer that originates in the kidney. Clear cell RCC is the most common type, accounting for about 75% of cases. Risk factors include environmental exposures and hereditary conditions. RCC is staged using the TNM system, where higher T and N classifications and the presence of metastases (M1) indicate more advanced disease. Treatment depends on the stage, with surgery being the main treatment for localized disease and targeted drug therapies or immunotherapy used for advanced or metastatic RCC. Prognosis varies by stage, with 5-year survival rates of 80-100% for stage I disease but only 0-20% for stage IV.
Neuro Urology...Fantastic presentation by Prof Drake of Southmeadmeducationdotnet
- The document discusses the initial assessment and management of neurogenic urinary incontinence. It covers taking a detailed history, performing a neurological examination, investigating with urinalysis and urodynamics, and classifying the neurological lesion. Special considerations for safety include assessing for detrusor sphincter dyssynergia, poor bladder compliance, autonomic dysreflexia, and latex allergies before managing symptoms. Urodynamics helps evaluate the bladder and sphincter function to guide appropriate treatment and ensure renal safety.
This document describes the case of a 21-year-old female presenting with urinary retention symptoms for 2 years. Examinations and investigations revealed normal anatomy but inability to void urine. This is diagnosed as Fowler's syndrome, a condition characterized by involuntary contraction of the urethral sphincter muscle preventing relaxation and voiding. Treatment involves self-catheterization or sacral nerve stimulation to modulate the sphincter and restore voiding. The condition is thought to be due to abnormal nerve signaling between the bladder and sphincter muscles.
This document provides information on benign prostatic hyperplasia (BPH):
- It describes the anatomy and zones of the prostate gland and discusses theories on the causes of BPH related to hormone levels and aging.
- The pathology, clinical features, investigations, management options including medications, minimally invasive procedures, and surgeries for BPH are summarized. Surgical options include transurethral resection of the prostate (TURP) and newer laser procedures.
- Complications of treatments like TURP are noted. Indications for medical versus surgical management are provided.
- The document discusses neurogenic bladder and its management. It provides an introduction to bladder anatomy and function and describes different types of neurogenic bladder caused by conditions such as myelomeningocele, occult spinal dysraphism, sacral agenesis, cerebral palsy, and traumatic spinal injuries. It also discusses evaluation, including history, physical exam, radiographic assessment, and urodynamics. The goals and methods of neurogenic bladder management in children are to preserve the upper urinary tract and improve quality of life through techniques such as clean intermittent catheterization.
This document provides an overview of benign prostatic hyperplasia (BPH). It defines key terms related to BPH and lower urinary tract symptoms. It describes the histopathology and molecular etiology of BPH, risk factors such as aging and genetics, and the pathophysiology whereby BPH causes bladder outlet obstruction and changes in bladder function. It also discusses complications of BPH, correlations with severity measures, and a staging system for determining appropriate treatment.
This document provides an overview of fecal incontinence, including its:
1) Functional anatomy of the rectum and anal sphincter complex
2) Physiology of defecation and the rectoanal inhibitory reflex
3) Causes and risk factors such as aging, neurological diseases, and pelvic floor dysfunction
4) Evaluations including anorectal manometry and endoanal ultrasound
5) Treatments including diet, bowel training, biofeedback, plugs, and medications to reduce stool volume
This document discusses overactive bladder (OAB). It defines OAB as a clinical syndrome of urgency, usually with frequency and nocturia. It can occur with or without urge incontinence. The prevalence of OAB increases with age and it affects both men and women. Treatment progresses from behavioral modifications and oral medications to minimally invasive procedures like botulinum toxin injections or sacral nerve stimulation for refractory cases. More invasive treatments like augmentation cystoplasty or urinary diversion are reserved for cases that fail less invasive options.
JOURNAL about long term lithium treatments in elderly patients with mild cogn...anintamelie
The document describes a randomized clinical trial that investigated the effects of long-term low-dose lithium treatment in older adults with amnestic mild cognitive impairment. 61 participants were randomly assigned to receive either lithium or placebo treatment for 2 years, followed by a 2-year extension phase without blinding. The primary outcomes were changes in cognitive and functional scores after 2 years. Secondary outcomes included neuropsychological tests, CSF biomarkers, and conversion to dementia. Results showed that the lithium and placebo groups were similar at baseline on sociodemographic, clinical, and biological measures.
Parkinson's disease is a brain disorder that progressively affects a person’s ability to control body movements, caused by a disorder of certain nerve cells in a part of the brain that produces dopamine, a chemical messenger the brain uses to help direct and control body movement.
Early diagnosis of Parkinson's disease gives you the best chance of a longer, healthier life. This presentation covers the information about biomarkers for Parkinson Diseases which include biological, physiological and imagine candidate / novel biomarkers.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
This document provides an introduction to the integrative medical approach of Endobiogeny. It discusses the objectives and components of Endobiogeny, which include a detailed patient history, physical exam, classical labs/imaging, and Biology of Functions assessment to evaluate the qualitative and quantitative state of the human organism. Endobiogeny aims to understand disease and health through an integrated analysis of physiological and endocrine relationships and functions. The document provides examples of how Endobiogeny analyzes clinical conditions like Polycystic Ovarian Syndrome through this integrative lens.
This document discusses neurogenic bladder and its management. It begins by outlining the physiology of normal bladder control and describes various types of neurogenic bladder dysfunction that can occur depending on the level of spinal cord or brain injury, including detrusor hyperreflexia, detrusor sphincter dyssynergia, and detrusor areflexia. Diagnostic investigations and treatments are then discussed, including medications, catheterization, neuromodulation, and surgeries. The goal of treatment is to balance bladder emptying and continence for each type of neurogenic bladder dysfunction.
This document provides an overview of multiple sclerosis (MS). It defines MS as an immune-mediated progressive demyelinating disease of the central nervous system. The causes include autoimmune activity and genetic predisposition. In MS, sensitized T cells cross the blood-brain barrier and remain in the central nervous system, promoting damage. Clinical manifestations include fatigue, weakness, numbness, vision problems, and pain. Diagnosis involves MRI, cerebrospinal fluid analysis, and other tests. Treatment includes medications like corticosteroids, mitoxantrone, and amantadine to manage symptoms and slow progression. Nursing care focuses on assessing neurological function and managing issues like incontinence, speech and swallowing difficulties.
Practical bowel management in MS - Maureen CoggraveMS Trust
Aims:
- Understand concept of neurogenic bowel dysfunction (NBD) as seen in people with MS
- Appreciate impact of NBD on quality of life
- Understand the importance of case finding
- Be aware of assessment methods in NBD
- Be aware of potential methods of management, particularly conservative interventions
- Be aware of resources to support management
Descending perineum syndrome (DPS) is characterized by the ballooning of the perineum below the pelvis during straining. It is caused by excessive straining during bowel movements which impairs pelvic floor muscle tone over time. This leads to a descent of the pelvic floor and symptoms like obstructed defecation and eventually fecal incontinence. DPS involves the anterior, middle, and posterior pelvic areas in women. Accurate diagnosis requires examination, imaging, and functional tests to evaluate DPS stage and severity. Treatment may involve biofeedback, pelvic floor exercises or surgery depending on symptoms, stage and response to conservative therapies.
Polycystic kidney disease (PKD) is a genetic disorder that causes fluid-filled sacs, called cysts, to form in the kidneys. These cysts can grow over time and interfere with the kidney's ability to function properly. PKD can lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD), which may require dialysis or a kidney transplant.
There are two types of PKD: autosomal dominant PKD (ADPKD) and autosomal recessive PKD (ARPKD). ADPKD is the most common form and usually develops in adulthood, while ARPKD is a rarer form that usually develops in infancy or childhood.
Symptoms of PKD can include high blood pressure, back or abdominal pain, headaches, urinary tract infections, and blood in the urine. However, many people with PKD may not experience symptoms until later stages of the disease.
There is no cure for PKD, but treatment options can help manage symptoms and slow the progression of the disease. These may include blood pressure medication, pain management, antibiotics for infections, and lifestyle changes such as a healthy diet and exercise. In some cases, surgery may be necessary to remove a large cyst or to transplant a new kidney.
Etiology and neurobiology of obsessive compulsive disorderSimranSandhu673667
This document provides an overview of the etiology and neurobiology of obsessive-compulsive disorder (OCD). It discusses the key topics of diagnosis, neurobiological theories, psychodynamic theories, learning-based theories, cognitive theories, and summary. The neurobiology section outlines the neuroanatomy of OCD including brain regions like the anterior cingulate cortex, orbitofrontal cortex, basal ganglia, and cortico-striatal-thalamic circuits. It also discusses the neurochemistry involving serotonin, dopamine, and glutamate. Neuroimaging findings from MRI, fMRI, and DTI studies are summarized as well. Finally, psychodynamic theories involving Freud's psychosexual stages of development and the case
1. The document discusses the preoperative assessment and management of BPH-associated incontinence, which can include urge, overflow, and post-prostatectomy incontinence.
2. A thorough preoperative evaluation is important to identify contributing factors and assess sphincter function, as TURP can impact continence.
3. Evaluations include history, exams, tests like PVR and urodynamics to determine the type of incontinence and guide treatment selection. Precise tests like multichannel urodynamics are most informative.
PUJO is a restriction of urine flow from the renal pelvis to the ureter that can lead to renal deterioration if left uncorrected. It is a common cause of antenatally detected hydronephrosis, found in around 50% of cases. Obstruction causes progressive changes including renal pelvic and calyceal dilation, thinning of the renal cortex, interstitial fibrosis, and loss of renal function over time. Diagnosis involves renal ultrasound, voiding cystourethrogram, and diuretic renal scintigraphy to evaluate anatomy and function.
Similar to OVERACTIVE BLADDER NEW APPROACH.pptx (20)
1. Testicular cancer is most common in young men aged 20-40 years and accounts for 1% of all cancers in men.
2. Survival rates have improved in the last 15-20 years due to better understanding of the disease, reliable tumor markers, cisplatin-based chemotherapy, and modified surgical techniques.
3. Germ cell tumors make up 90-95% of testicular cancers and have predictable patterns of local and lymphatic spread that aid in staging and treatment.
Renal cell carcinoma (RCC) is a cancer that originates in the kidney. Clear cell RCC is the most common type, accounting for about 75% of cases. Risk factors include environmental exposures and hereditary conditions. RCC is staged using the TNM system, where higher T and N classifications and the presence of metastases (M1) indicate more advanced disease. Treatment depends on the stage, with surgery being the main treatment for localized disease and targeted drug therapies or immunotherapy used for advanced or metastatic RCC. Prognosis varies by stage, with 5-year survival rates of 80-100% for stage I disease but only 0-20% for stage IV.
Hydronephrosis is the dilatation of the renal pelvis and calyces caused by partial obstruction of urine flow. It can be caused by primary/idiopathic factors or secondary to extramural, intramural, or intraluminal issues. Clinically, it presents as renal swelling and features of the underlying cause. Investigations include imaging like ultrasound, CT, MRI. Treatment depends on the cause but may involve pyeloplasty surgery to repair the pelviureteric junction or nephrectomy in severe cases.
Benign disorders of the prostate include benign prostatic hyperplasia (BPH) and prostatitis. BPH involves hyperplastic growth of the prostate gland, leading to obstruction of urine flow. Common symptoms are urinary hesitancy, straining, and incomplete emptying. Evaluation involves history, exam, PSA, and imaging. Treatment options include medications like alpha blockers and 5-alpha reductase inhibitors as well as surgery. Prostatitis causes inflammation of the prostate and can be acute or chronic.
Prostate cancer is another common benign disorder, where malignant cells form in the prostate gland. Risk increases with age. Early detection relies on digital rectal exam and PSA screening. Staging involves biopsy
This document discusses transitional cell carcinoma of the bladder. It notes that 90% of bladder cancers are transitional cell carcinoma, while 5% are squamous cell carcinoma and 1% are adenocarcinoma. It covers causes, staging according to the TNM system, types of bladder tumors, behavior, symptoms, investigations, and treatments which include transurethral resection of the bladder tumor (TURBT) for non-muscle invasive tumors and radical cystectomy for muscle-invasive tumors. Recurrence rates are higher for carcinoma in situ, high grade tumors, and those with a high chance of recurrence, so intravesical BCG may be used after TURBT for these cases.
This document discusses the standard and emerging strategies for prostate MRI. The standard multiparametric MRI combines T2-weighted imaging with two functional techniques among DWI, DCE, and MRS. Version 2 of PI-RADS provided simplified guidelines. Emerging less-is-better strategies include biparametric MRI without contrast, abbreviated protocols, and reduced acquisition times. Different-is-better strategies explore objective biomarkers and computer-assisted diagnosis to reduce variability between human readers. The standard continues evolving while less invasive alternatives aim to expand availability.
The document discusses arteriovenous (AV) fistulas for hemodialysis access. It describes the need for well-perfused venous access in end-stage renal failure patients undergoing hemodialysis. The optimal location is a distal forearm fistula that is superficial, straight, and has adequate blood flow of at least 500-700 cc/min. The document outlines guidelines for fistula creation timing and types including radiocephalic, brachiocephalic, and grafts. It provides details on patient evaluation, surgical strategy, maturation criteria, complications, and post-operative care of AV fistulas.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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2. INTRODUCTION
• International Continence Society (ICS) has defined
OVERACTIVE BLADDER as a storage symptom
syndrome characterised by “urgency, with or without
urgency urinary incontinence (UUI), usually with
increased daytime frequency and nocturia”
• Current guidelines for management propose a linear
pathway, based purely on treatment invasiveness
• Unclear results of recent randomised controlled trials
(RCTs) comparing surgical options [3] highlight the
limitation of this “one size fits all” approach
3. AIM OF THIS ARTICLE
• difficulty in identifying the underlying pathology
for the development of OAB in most patients, it is
often labeled as “idiopathic”
• aim of the present review is to provide an
updated and comprehensive overview of the
potential pathophysiology underlying OAB, with
the hope that describing clinical phenotypes may
lead to a personalised approach to therapy.
4. EVIDENCE ACQUISAITION
• A PubMed-based literature search was
conducted in April 2018, to identify
randomised controlled trials, prospective and
retrospective series, animal model studies,
and reviews.
7. Detrusor overactivity (DO)
• Detrusor overactivity (DO) is defined as “a urodynamic
observation characterised by involuntary detrusor
contractions during the filling phase which may be
spontaneous or provoked”
• presence of DO in only 50% of female OAB patients has
prompted further research to consider the existence of
alternative mechanisms relating to the role of the
urothelium, suburothelium, urethra, and central
nervous system (CNS) in the pathogenesis of OAB
8. Myogenic hypothesis:
urgency originating from the detrusor
• DO-driven urgency is mostly related to myogenic
dysfunction inherent to denervation-related
supersensitivity – BRADING
• histological changes of the detrusor, leading to
abnormal electrical coupling of smooth muscle cells so
that physiological micromotions become synchronised
into active involuntary detrusor contraction – DRAKE
• Increased afferent signalling resulting from
urothelial/suburothelial dysfunction may contribute to
uninhibited detrusor contractions
9. • Rx –
use of conservative management and vaginal
application of oestradiol, antimuscarinics, sacral
neuromodulation (SNM), or intradetrusor botulinum
toxin injections are supported by level 1 evidence in
patients with urodynamically proven DO
10. Urotheliogenic hypothesis:
urgency originating from the bladder urothelium
• growing body of evidence on the role of
increased activity of bladder afferents during
bladder filling support the idea of urgency
resulting from urothelial/suburothelial
dysfunction in some patients, which may not
manifest as DO
• Spontaneous contractions of the mucosa itself,
originating from the muscularis mucosae, have
been suggested as a possible origin of urgency
11. • Rx –
Drugs modulating the sensory pathways, bladder
afferent firing, and release of neurotransmitters,
such as botulinum toxin, b3-adrenergic receptor
agonists, or phosphodiesterase inhibitors, from the
urothelium may be regarded as valuable options in
these patients
12. Urethrogenic hypothesis:
urgency originating from the urethra
• Entry of urine into the proximal urethra in patients
with stress urinary incontinence (SUI) may stimulate
urethral afferents, inducing and/or increasing DO
• Typically experience urgency when moving from a
sitting or lying position to a standing position
• constant leakage in patients with severe SUI may result
in a chronically underfilled, “defunctionalised” bladder.
Such patients may develop DO or impaired compliance
generating urgency
13. • Rx –
– surgical repair of SUI improves storage LUTS in
some patients with mixed incontinence, but the
role of SUI surgery for isolated OAB in selected
patients with “urethral urgency” has not been
evaluated
– Duloxetine may hypothetically be an interesting
option in patients with “urethral urgency” by
increasing urethral tone and has been shown to
be an effective treatment for OAB
14. Supraspinal hypothesis:
urgency originating from the brain and brainstem
• decreased capacity to functionally integrate
afferent information or reduced supraspinal
inhibitory control on the micturition reflex has
been suggested as a possible mechanism of OAB
• two distinct subtypes of “brain OAB”: one with
and one without DO
• older age and a greater burden of white matter
damage in patients with DO are associated with
more severe functional urinary impairment
15. • Rx –
– Behavioural therapies seem appropriate to treat
“brain OAB” by offering the possibility of
retraining the supraspinal network to function
normally
– SNM has been shown to influence activity in
several brain areas involved in micturition control
and to promote neuroplastic reorganisation of
cortical activity
16. Detrusor underactivity
• voiding symptomatology of detrusor
underactivity has been shown to overlap with
OAB, and urgency the most common symptom in
patients with urodynamically proven detrusor
underactivity
• underactive bladder symptoms are associated
with an increased prevalence of urgency, UUI,
and nocturia
17. • Rx –
– no treatment has yet been proved clinically
effective in restoring detrusor contractility
– clean intermittent self-catheterisation is still
regarded as the standard of care
19. Metabolic syndrome
• A link between metabolic syndrome and OAB
has been demonstrated in many studies,
especially between obesity and OAB
• OAB may have its own pathophysiology in
patients with metabolic syndrome, relying on
increased mechanical load stimulating sensory
afferents of the trigone and bladder neck
20. • Rx –
– the current established treatment options for OAB,
such as antimuscarinics, SNM, and botulinum toxin,
have been reported to be less effective in patients
with metabolic syndrome
– b3-adrenoreceptor agonist mirabegron, which was
designed initially as an antiobesity drug,was found to
be equally effective in both obese and nonobese OAB
patients
– treatments targeting obesity, such as weight loss
programmes and bariatric surgery, may be regarded as
the most effective therapeutic options
21. Affective disorders
• emotional stress and a history of anxiety/depression may be
risk factors for the development of OAB in women
• Serotonin and Corticotrophin-releasing factor (CRF) has been
investigated as a possible common pathophysiological
contributor to OAB and anxiety/depression
• Transient receptor potential (TRP) channel dysfunctions
might also play a key role in the co-occurrence of affective
disorders and OAB
• Central sensitisation, defined as increased responsiveness of
nociceptive neurons in the CNS to normal or subthreshold
afferent input, has recently been suggested as a last common
pathophysiological cofactor of anxiety/depression and OAB
22. • Rx –
– Duloxetine has been reported to improve significantly
frequency and urgency in an RCT of female OAB
patients and may be a valuable candidate for the
treatment of stress-induced OAB
– Duloxetine, TRP vanilloid (TRPV) antagonists, or CRF
antagonists may target shared biological underpinning
of anxiety/depression and OAB, and thus, might
become treatment options foremotional stress-
induced OAB
– SNM is the most widely studied and properly assessed
treatment in our current armamentarium in this
population
23. Sex hormone deficiency
• up to 70% of women relating the onset of
urinary incontinence to their final
menstruations
• OAB in these patients is commonly associated
with UTIs and vulvovaginal symptoms such as
vaginal dryness, itching, and dyspareunia -
genitourinary syndrome of menopause
24. Urinary microbiota
• Bacterial DNA and a higher load of bacteria are more
frequently detected in patients with UUI, with possibly
decreased urinary microbiome diversity
• Lactobacillus spp. (eg, L.crispatus) may be markers of a
healthy female bladder with a possibly lower
Lactobacillus load in patients with UUI
• Intravaginally administered Lactobacillus has shown
promise in preventing recurrent UTIs, no studies to
date have investigated the role of Lactobacillus
probiotics in OAB
25. Functional gastrointestinal disorders
• bladder and colorectum have the same
embryological origin from the cloaca
• common neural pathways may also be the drivers
of cross-sensitisation defined as sensitisation of
afferent nerves of one of the pelvic organs due to
an acute insult in the other (pelvic organ cross
talk)
• gastrointestinal condition that has most
frequently been inter-related to OAB is irritable
bowel syndrome (IBS)
26. Autonomic nervous system dysfunction
• Sympathetic, parasympathetic, and somatic
nerves are well-known determinants of lower
urinary tract physiological functioning and are
altered in several neurological conditions proven
to be associated with lower urinary tract
dysfunction (eg, Parkinsonism, multiple sclerosis)
• subclinical autonomic nervous system
dysfunction n may be a causative factor of
“idiopathic” OAB
27. HOW TO IDENTIFY THE PHENOTYPES
1. Clinical examination and medical history
2. Urodynamics
3. Futuristic diagnostic testing
– Serum and urine concentrations of CRF/cortisol
– Functional brain imaging
– Urinary markers – nerve growth factor, brain
derived neurotrophic factor
– 16S RNA sequencing and expanded quantitative
urine culture
29. LIMITATIONS
• new concept is not based on high-level
evidence studies
• lack of a standardised definition of the various
OAB pathophysiological features as well as the
lack of consensual techniques to diagnose
these key contributing factors
• exclude the role of bladder outlet obstruction
and bladder pain syndrome in our hypotheses
30. current treatment strategies rely upon therapy invasiveness and cost rather than the
appropriateness to patients’ and symptom characteristics
32. TAKE HOME MESSAGE
• There is not one single form of OAB syndrome but
rather several OAB phenotypes based on the
underlying mechanisms and pathophysiological
cofactors
• new studies should assess the outcomes of the current
OAB treatments for each different OAB subpopulation,
leading to more personalised medical approaches
• due to poor long-term compliance with existing
pharmacotherapy, effectiveness of a tailored versus a
“one size fits all” treatment approach should be looked
into