(Microsoft PowerPoint OAB4public Rx .ppt [\254\333\256e\274\322\246\241])

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1 2 尿急尿頻膀胱過度活躍症治療頻頻尿何時了小便功能知多少 1. Watchful Waiting 2. Medical Treatment -尿頻與膀胱過度活躍膀胱過度活躍症症(二) 治療 3. Surgical Treatment 藥物療法手術療法 Dr Manuel BW QUE 郭文偉醫生泌尿外科專科醫生 3 尿急尿頻膀胱過度活躍症 4 情緒/ 環境/ 抑鬱/ 抑鬱 / 壓力亦可以引致尿頻適合輕度適合輕度患者患者尿急尿急尿頻尿頻多夜尿治療減少咖啡茶酒刺激性飲料減少晚上飲料避免傷風藥止咳藥精神科藥物避免便泌保持大便暢通避免憋尿久坐定期適度的運動飲食清淡避免辛辣等刺激性食物盤底肌肉運動 5 6 Pelvic Floor Exercise / Kegel Exercise 盤底肌肉運動 =提肛運動每日三次每次五下每下五秒一個月見效但必須持之以恆 1

2 郭文偉醫生 7 Pelvic Floor Exercise / Kegel Exercise 盤底肌肉運動 = 提肛運動藥物療法二十年前十年前 Imipramine(TCA) Probantheline Oxybutynin, 1972 郭文偉醫生 8 Anti-muscurinics Tolterodine(Detrol/ Detrusitol), 1998 OxybutyninXL (DitropanXL), % 口乾 / 眼澀 / 眼矇 / 便秘 82% 挨不過六個月影响記憶力現在 VESIcare(Solifenacin) 郭文偉醫生 9 launched in 2005(FDA approved 2004) Solifenacin is a competitive M3 antagonist with a long half-life (45 68 hours, about 50hr). Oncedaily, 5mg or 10mg indicated for the treatment of OAB with symptoms of urge incontinence, urgency, and urinary frequency. Reference: 現在郭文偉醫生 10 VESIcare(Solifenacin) 43% of patients reported no urgency. 42% of patients returned normalised voiding frequency (<8 voids/day). Haab f, Cardozo L, Chapple C, Ridder AM for the Solifenacin Study Group. Eur Urol 2005: 47(3): 郭文偉醫生 11 郭文偉醫生 12 藥物療法藥物療法口乾便秘眼澀 2

3 13 手術 InterStim Therapy 14 Sacral Nerve Stimulation for Urinary Control (Neuromodulation Neuromodulation)) 15 InterStim Therapy 16 S.N.S 第一步 Sacral Nerve Stimulation for Urinary Control 用手術方法植入導電線測試脈冲電擊的療效 (Neuromodulation Neuromodulation)) 每個 USD 11,000 手術分兩部分 InterStim Therapy S.N.S 第二步 2.Implant Procedure 用手術方法植入起博器 (只適用於三份二病人) Patients with a successful test stimulation go on to implantation of the internal pulse generator. Sacral Nerve Stimulation for Urinary Control 原理用電流脈冲常帶來 the application of an electrical current to a sacral nerve in order to rebalance rebalance or modulate the reflexes involved in lower urinary tract control Implantation 3

4 郭文偉醫生 19 郭文偉醫生 20 有何不同? SNS 神經調和針灸治療郭文偉醫生 21 InterStim Therapy Sacral Nerve Stimulation 郭文偉醫生 22 Ultimately, all illness is due to a disruption of balanceof yin and yang within the body, and a disruption of flow of qi application of an electrical current to a sacral nerve in order to rebalance or modulate the reflexes involved in lower urinary tract control Ultimately, all illness is due to a disruption of balance of yin and yang within the body, and a disruption of flow of qi 郭文偉醫生 23 針灸治療 Acupuncture Points- 1 Acupuncture in OAB 針灸治療 Acupuncture 郭文偉醫生 24 WHO List of Indications 夜遺尿神經膀胱功能失調失禁尿瀦留 Bannerman R H 1979 Acupuncture: the WHO View. World Health, December, p Enuresis and neurogenicbladder dysfunction are among the 43suitable indications Urinary incontinence and urinary retention are among the further 64 conditions listed in 1996 by WHO that were considered to be supported Mainland China, full time dedicated Acupuncture Prostate Clinic 4

5 25 Percutaneous posterior tibial nerve stimulation 26 Percutaneous posterior tibial nerve stimulation 27 Extracorporeal Magnetic Innervation (ExMI) ExMI) (NeoControl) NeoControl) 男性健康 28 經尿道切除前列腺手術 BJU Int 2004;93: 男性健康 29 前列腺激光前列腺激光/ /氣化手術手術 30 尿急尿頻膀胱過度活躍症反思: 5

6 尿頻是可以被控制甚至治癒的對不起對不起你並膀胱過度活躍症不特別不特別尿急尿頻的大有人在有人在 33 OAB Debate 膀胱過度活躍症原來並不是一個病膀胱過度活躍症原來只是一堆徵狀的統稱尿急 urge incontinence Usually with frequency and nocturia, When there is no proven infection or other obvious pathology (no local or metabolic factors) 尿急尿急尿頻尿頻多夜尿情緒/ 環境/ 抑鬱/ 抑鬱 / 壓力亦可以引致尿頻膀胱過度活躍症 symptomatic diagnosis of urgency urgency, with or without 32 尿頻夜尿失禁排除感染排除感染或其他原因 36 適合輕度適合輕度患者患者減少咖啡茶酒刺激性飲料減少晚上飲料避免傷風藥止咳藥精神科藥物避免便泌保持大便暢通避免憋尿久坐定期適度的運動飲食清淡避免辛辣等刺激性食物盤底肌肉運動 Dr Manuel BW QUE 郭文偉醫生泌尿外科專科醫生 6

兒童排尿障礙

兒童排尿障礙兒童排尿障礙 Pediatric Voiding Dysfunction 新店慈濟醫院慈濟醫學院泌尿科 Division of Urology, Buddhist Xindian Tzu Chi Hospital and Medical School of Tzu Chi University 楊緒棣醫師 Stephen SD Yang, MD, PhD