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Jean pierre-giolitto. incontinence urinaire

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Jean pierre-giolitto. incontinence urinaire

  1. 1. INCONTINENCE URINAIRE De l’adulte 4 octobre 2007
  2. 2. Homme:pathologie de la prostate• 74 ans ;hbp 5ans,traité par @-+plantes;• Aggravation pk;fuites par imperiosité;gouttes retardataires post miction• psa :3.5 ratio 24%• Echo/47 cc;residu:90cc,pas de patho autre• Debit:9ml/sec• Craint l’itv à cause de l’incontinence
  3. 3. Resecton prostatique• Amelioration symptomes:80-90%• Incontinence:1-3%;imperiosité pre op :4 m• Gouttes retardataires: idem• Ejac retrograde:30-90%• Impuissance:3-15%• Stenose uretre:5-10%• Recidive hbp:30% à 10 ans
  4. 4. Cancer prostatique• 69 ans;psa:5.8; 2 bp>0 droite;gleason4+3• bilan<negatif• Craint l’iue et l’impuissance• Demande conseil sur l’itv ou la radiotherapie
  5. 5. Cancer prostate• Radio ext:faible risque iue sauf si rep• Curith:3-10%iue• Chir:3-10% à preciser selon la technique et l’expertise• erection/:preservation nerfs:70%à 2 ans• Radio:dysf erectile différée à 2 ans• But curatif:chir=ttt n°1
  6. 6. Prostate et parkinson• 77 ans park plus années et hbp depuis 10• Aggrav pk/10mn,imperieux;petites fuites,protection 3/jour• Psa:2.9;echo:50gr,residu:100cc• Traité par inhib 5@r• Que faire: rien; ex urodynamique;• anticholinergiques.,@- ,resection prostate
  7. 7. Incontinence urinaire de la femme• 35 ans sport en salle 3/semaine ;mince et musclée;fuites au saut ;protections• Que faire: arréter le sport; ex urodynamique ; continuer avec les pads.• Rééducation;mais quelle utilité si déjà tres musclée• Donner du ditropan
  8. 8. Incontinence à l’effort• expliquer: inegalité /iue• Facteurs genetiques avec tb du collagene• Fact obstetricaux:gross multiples,gros bb• Forceps episio• Sports: sauts,basket,volley,course de fond
  9. 9. Incontinence urinaire de la femme• 45 ans:iue+qqimpériosités depuis 3 ans• 15 kiné:résult moyen• Examen:fuite enjet;bonney>0;cystocele 1• A consulté 3 chir:• 1:coelio:promontofixation+burch• 2:TVT obturateur• 3:burch open
  10. 10. Chirurgie de l’iue• Burch coelio:mauvais resultat à 2 ans• promontofixation: non car pas de gene• Burch open:pourquoi pas:90%à 3 ans,80à7ans=longtemps le standard• TVT:nouveau standard:95%à 2 ans;peu de dégradation ensuite ;rcul 10 ans• TVT:5%impériosité de novo;debit lent 50%
  11. 11. Chirurgie et incontinence• La patiente a un tvto:ex résultat• 2 ans plus tard consulte pour boule vaginale:examen:cystocele 2-3• Que faire: rien; nouvelle kiné• 2 chir:• 1:hysterectomie v basse+cure de prolapsus avec prothese• 2:promontofixation coelio sans hysterectomie
  12. 12. Incontinence urinaire de la femme agée• 78 ans iue+changement de position+à l’eau• 4-5 pads/jour• Ne veut pas de kiné;décidée pour la bandelette• Que faire: l’encourager;cbu;echo. Ex urodynamique; anticholinergique;toxine botulinique

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