urological treatments
Urinary incontinence Urinary incontinence is a condition that affects the life of a great number of men and women around the world. Although rarely put lives at risk, however, negatively affects the quality of life, causing disability and suffering to those who suffer significant morbidity and società.Negli for the U.S. National
Istitutes
of Health showed that urinary incontinence is not is only a medical problem but also economic, costing more than $ 12 billion a year. Urinary incontinence affects the lives of 15 to 30% of women of all age from a social, psychological, occupational, domestic, physical and sexual. Many women try to hide the problem at all, often including the husband, because of the shame they feel. Traditionally the treatment of urinary incontinence was eminently surgical or pharmacological last decade there has been a prevalence of behavioral techniques and especially rehabilitation. It 'very important, in close collaboration with the gynecologist and the urologist, make a preliminary and careful evaluation of clinical conditions associated with urinary incontinence, and clearly define the type of incontinence present (stress, urge, mixed, or overflow) . In any case, the re-education techniques, appropriately implemented depending on the specific problem, have as their objective the improvement of the "performance" so as to allow the perineal perineum can exert its functions adequately support the pelvic viscera, reinforced-urethral sphincter and to counter iperpressioni endoaddominali.Ogni Single dysfunction requires an appropriate treatment, including the identification of risk factors for urinary incontinence and prolapse genitale.La rehabilitation uro-gynecological practice that is essentially based on biofeedback (BFB), the pelvic-perineal physiotherapy (CPP) and functional electrical stimulation, from time to time be given the most suitable program, emphasizing one or the other of the methods after a careful assessment of the case. In general, however, the best results are obtained by combining the three types of treatment. Saturday, July 16, 2005
Difference King And Superking
Biofeedback
urinary continence is closely dependent on a proper central and peripheral nerves and a lack of intrinsic lesions of the lower urinary tract and pelvic floor. Many are called reflexes are involved in the regulation of bladder-sphincter function (Barrington, 1915; Mahony, 1977). The mechanisms involved in peripheral inhibition of bladder reflex arcs are represented by the pelvic-hypogastric and pudendal-ipopgastrico (acting facilitator) and pelvic-pudendal reflex arc (for injunction). E 'Stao shown that the reflex inhibition (relaxation) of the urethral muscles (smooth and striated) and pelvic floor is associated with detrusor contraction. Similarly, the inhibition of detrusor due to a tonic reflex inhibitory effect exerted by supraspinal structures in the sacral micturition center, is influenced by a reflex contraction of the sphincter muscle-perineale.La electrical stimulation can normalize the activity of stretch receptors in the perineal muscles and stabilize the sacral center of micturition it can also improve fatigue resistance and contractile force of the pelvic uscolatura, with subsequent benefit of the urethral closure mechanism under stress.Teoricamente the mode of stimulation are as follows: • stimulate perineal · stimulation of sacral anterior roots · sacral intradural stimulation (Brindley seconds), extradural (second Tanag) or intraforaminale (according to Schmidt); • stimulate intravescicale.Nell 'perineal electrostimulation electrodes are most widely used endocardial electrode (endovaginal) or surface electrodes (used in technical TENS or interferential current). Electrodes intra-cavitary are located (usually two or three) on ring-shaped vaginal probes of various sizes. It 'obvious that the probe electrostimulation should be on the basis of clinical and anatomical conditions of the patient (shape and length of the vagina, perineal muscles of the quality, type and degree of potential vaginal prolapse. Electrostimulation equipment are "compact" ( outpatient) or miniature (For home use), both types of equipment to deliver the most current biphasic (mandatory for home treatment) to eliminate any effects elettropolari.Il problem of disinfection and sterilization of the probes can be solved with the use of Sporicidin (solution based on phenol and glutaraldehyde). An important speech nell'elettroterapia incontinence is represented by the current interference, which exhibit some undoubted quality: · their prevalence (in the UK and Australia in particular), · their high trophic action Pain deep · not need to use the electrodes endocavitari.La interferential current can inducing muscle stimulation in a normally innervated muscle, irrespective of its search engine specific points and avoiding the side effects on the skin, induced by other types of current in order to achieve greater penetration in profondità.L 'goal of therapy interference is to induce a stimulating effect on the pelvic floor muscles (mainly represented by the levator ani) in order to determine: The socket of the same muscle cosacienza · an enhanced tropism and tone; o To 'reflex detrusor inhibition (Nakamura et al., 1986; Ohlsson et al., 1986). For an effective interferential therapy is essential that two parameters: 1. proper positioning of the electrodes, 2. the selection of appropriate electrical parameters, depending on the type of urinary incontinence in which you rivolge.Per regarding the placement of the electrodes, there are two methods that can be applied: the bipolar and tetrapolar. The treatment can be performed daily or every other day, one additional application of the electrodes is the one with two electrodes placed at the top, at the retrotrocanterica region and the other two places lower, at below the gluteal fold (Savage, 1984).
Physiotherapy
In
rehabilitation of urinary incontinence kinesiotherapy occupies an important place, representing the conjunction of movement (chinesis) and treatment (terapeia), for physical therapy should be understood to mean all forms of muscle activation and joint exercises simple and complex flows to a therapeutic purpose, which have that for the purpose miglioramenro appearance of postural and dynamic of the human body. The various maneuvers used are used schematically, and in a purely aaccademico, divided into passive, active, and active resistance against postural, but now understanding the importance of "knowing oneself" and the plan as a central organizing body of afferent and efferent and at the same time they organized, the prevalence of consciousness motion than the muscle and joint mechanics have turned the act of physical therapy in a series of amendments to the ball "functional" by an individual who can go far beyond the act itself. At the present state would be more appropriate to split the exercises riaabilitativi in \u200b\u200bacts that do not require the patient's attention and exercise that should involve full coscienza.Relativamente methods to use the classification suggested by Boccardi still retains an undeniable educational value and schematic:
· passive physical therapy, divided into: 1 . passive postural alignment 2. passive motion in relaxation 3. passive mobilization forced
· active physical therapy, divided into: 1
. active exercises general 2. active exercises segmental (free, assisted, against resistance)
3. neuromuscular facilitation techniques
4. functional rehabilitation
The acknowledged pioneer of rehabilitation perineal U.S. Arnold H. Kegel, the gynecologist who, more than 40 years, advocated perineal exercises to prevent and / or treat genital prolapse and female urinary incontinence. But even many years before in 1864 the Swedish Thure Brandt argued that the contraction of the adductor muscles actively involve all the muscles of the floor, especially if the patient lifted the upper basin, strengthened by this exercise, opposed the perineal muscles to improve resistance to the pressure of the viscera, thereby preventing the retroversion of the uterus that is stretching the legamenti.In Italy has seen since 1985 with a serious interest in pelvic floor physical therapy techniques, the scientific recognition of the dignity of the rehabilitation techniques of bladder-sphincter dysfunction-perineal by the International Continence Society in 1990 has been a goal and at the same time a starting point for all operators of physical therapy in the protocol settore.Oggi perineal dysfunction is divided in stages, put in place after a crucial preliminary phase of patients with adequate information and some preparatory sessions learning Kinesiology generale.Dopo some necessary background anatomy and physiology of bladder-sphincter-perineal should adequately inform the patient about the disease in place and point out the purpose of rehabilitation, physical therapy sessions during the pre-treatment is essential learning a good synergy of breath, reached only after reaching an optimal level of concentration and rilasciamento.L 'overall objective is to facilitate the realization by the patient's perineal muscle activity, via a "corticalizzazione" of Event engine body area poorly represented at the level of primary cortical areas, motor (area 4 of Brodmann) and sensory (areas 3, 1 and 2 of Brodmann). The sequential stages of perineal pelvic physical therapy program can be summarized thus: · awareness of the perineal region, and muscle activity of the elevator anus · consensual eliminazionedelle synergies agonists and antagonists; · "training" of the levator muscle; Automates perineal muscle activity to coincide with the stress of business life is more important than ever quotidiana.Estremamente rehabilitation pelvis perineal-awareness, racial factors, educational, religious and iatrogenic may lead to a lack of "awareness" of the sphincter-perineal accounts for the poor and not infrequently incorrect motoneurale recruitment to the request for a voluntary activation of muscle afferent activity resulting in less perineali.La also ensures that you enter into a vicious cycle which may, secondarily, to damage to the lift of morfoistologiche 'ano.In treatment chinesi perineal approach is therefore surely the first proprioceptive and uses all the techniques neuromotor re-education (proprioceptive neuromuscular facilitation) used to activate the central nervous system and to provoke a reflex, an adequate voluntary muscle activity. This is certainly the most delicate phase of the entire treatment program, as it depends largely on the overall therapeutic outcome.
Induratio Penis Plastica (IPP) or disease "La Peyronie"
Induratio The Penis Plastica (IPP) or Peyronie's disease, named after the surgeon to Louis XV who discovered it in 1743 , is a disease of the penis due to unknown, characterized by a circumscribed fibrosis of the tunica albuginea, the poorly vascularized sheath that covers the corpora cavernosa of the penis. The area of \u200b\u200bfibrosis, called "plaque" is a restriction on the elasticity of the face affected by the disease of the penis during erection, resulting in a curvature toward the sick side. The causes, as already mentioned, are not known. The frequent finding of plaque on the midline of the penis in the dorsal or ventral region, has been thought to many writers of the sixties and then more recently that, at the base of the pathophysiological process of the disease, there is trauma or repetitive microtrauma over time load of the erect penis that result in injury, though minimal, in that area of \u200b\u200bthe tunica albuginea which is at the level of the septum separating the two corpora cavernosa (septum intercavernoso). In fact, the lining of the corpora cavernosa has circular fibers around each fiber and longitudinal course that will play consensualmente.Sulla midline for these fibers trend orthogonal to each other meet intercavernoso in the septum. A trauma to the erect penis can detach these two layers of fiber tearing. These tears are the only or repeated achieve normal healing process of the body that produce phenomena at the beginning of local inflammation and, over time, the formation of a scar. This is the typical "plaque" of the IPP. Over time scar these processes are stabilized, there are deposited calcium salts, resulting in unchangeable calcified plaque, typical of the IPP stabilized. The IPP
predominantly affects middle-aged men, much more rarely young and elderly subjects. The epidemiological distribution is justified and at the same time, comforting the hypothesis etiological outlined above, placing it in relation to two factors: tissue elasticity and force young sessuale.Nei the enormous elasticity of the tissue is able to absorb the trauma inherent coital movement, the elderly are seeing a significant reduction in tissue elasticity which, however, is accompanied by a significant reduction of "energy" during sex. E 'in the fifth to sixth decade of life, while maintaining a high mechanical stress borne by the erect penis during intercourse, the penile tissues lose more or less gradually and more or less quickly than their elasticità.Devine et al. in 1992 reported the finding of the IPP almost exclusively in white (rare among blacks and none of the East).
disease in 50% of cases had sudden onset and another 50% of insidious onset and slow over time. Although this different mode of presentation of symptoms is to be in agreement with the etiological hypotheses that we reported. In fact, a patient has two memories of penile trauma accompanied by severe pain lasting from minutes to days elapsed approximately 1-4 weeks before the onset of curvature. The other half of the patients but does not remember a specific traumatic event. In the first case it is likely that the trauma has caused a laceration of sufficient importance to be accompanied by pain and functional impairment, more or less long, the second was probably a series of repeated microtrauma are the basis of the disease. However arising, the overt disease is manifested by an acute phase and a stabilization phase. In the acute phase, as we have seen that can occur immediately after trauma or after a variable period of time, the patient complains of pain or spontaneous erection and curvature of the erect penis and, less frequently, even in a state of flaccidità.E 'This phase will be done in therapy. At this stage, it follows, after a period of 12-18 months, the organization needed scarring of the plaque, the stabilization phase in which inflammatory processes are solved and a residual calcified plaque unassailable therapy. E 'therefore essential to attack the disease with the appropriate therapy in the acute phase, one in which the inflammation and scarring processes are still in place, to reduce scar formation and deposition of calcium salts. Peyronie's disease may be associated with an erectile dysfunction is because the pain and curvature, resulting in pain penetration for both partners have an important psychological effect on sexual activity negative, and because the changes in penile tissues, which are behind the possible cause of 'IPP, coincided with those that contribute to the determinism of organic erectile dysfunction. Many authors argue that the IPP is not in itself cause erectile dysfunction, but often precedes and / or behave as contributory cause of some forms of organic or psychogenic erectile dysfunction.
The diagnosis should be placed as early possibile.Molti authors have suggested several diagnostic protocols with the use of various methods. In most cases, the diagnosis of PPI is done with four simple ways: 1) accurate collection of patient history (mode and time of onset, symptoms, associated manifestations, sexual life), 2) autofotografie in at least two projections, the patient must be performed with an erect penis it possible to calculate the exact angle of curvature of the penis, and 3) physical examination performed by expert hands that allows highly accurate assessments of the disease state, 4) Ultrasound in penile flaccid penis and erection farmacoindotta.
Vitamin E at a dose of 200-400 mg x 2 times with di.Ionoforesi: PrismaFibraseBentelanoppure with Verapamil
The patient must be properly prepared: in the supine position, take a sheet of aluminum foil to avoid getting wet, which we place another sheet of paper to bed, and the two sheets have a hole from which we exit the penis, which must be carefully cleaned with pure alcohol at 60% in deionized water to avoid waste and interference with the penetration of drugs (if necessary advise the patient to make a local trichotomy). Above the piece of sponge, new and wet in deionized water, say a layer of sterile gauze and pour this medication from time to time usati.Gli electrodes are positioned on either side of the penis and use a current of 4 mill for at least 25 minuti.Insieme iontophoresis to use the laser and / or ultrasound with Lioton about one thousand placca.In generally care should be carried out on alternate days for at least two months in the first phase, and thereafter should be made every two or three months a series of at least ten sedute.I results are more positive than is the early 'intervention that reduces scar formation and deposition of calcium salts. In any case, because it is not common to see a patient in the acute phase, even after the results are remarkable: the pain disappears, decreases the curvature and reduces the area of \u200b\u200bfibrosi.A this regard, as is clear from recent studies andrological by stretching the penis, the tunica albuginea extends / expands and better vascularity, which is why we advise our patients perform small maneuvers of stretching and light massage of the penis on the plate.
The patient must be properly prepared: in the supine position, take a sheet of aluminum foil to avoid getting wet, which we place another sheet of paper to bed, and the two sheets have a hole from which we exit the penis, which must be carefully cleaned with pure alcohol at 60% in deionized water to avoid waste and interference with the penetration of drugs (if necessary advise the patient to make a local trichotomy). Above the piece of sponge, new and wet in deionized water, say a layer of sterile gauze and pour this medication from time to time usati.Gli electrodes are positioned on either side of the penis and use a current of 4 mill for at least 25 minuti.Insieme iontophoresis to use the laser and / or ultrasound with Lioton about one thousand placca.In generally care should be carried out on alternate days for at least two months in the first phase, and thereafter should be made every two or three months a series of at least ten sedute.I results are more positive than is the early 'intervention that reduces scar formation and deposition of calcium salts. In any case, because it is not common to see a patient in the acute phase, even after the results are remarkable: the pain disappears, decreases the curvature and reduces the area of \u200b\u200bfibrosi.A this regard, as is clear from recent studies andrological by stretching the penis, the tunica albuginea extends / expands and better vascularity, which is why we advise our patients perform small maneuvers of stretching and light massage of the penis on the plate.
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