Challenging Cases of LUTS

Case Study

Dr. Dyar Hameed Bajalan

Lecturer In University of Sulaymaniyah

Specialist Urologist
CASE #1
 Ms.N

43 years old women presented with mixed incontinence Since 10 years 

She have done TOT operation at 2016

But her stress didn’t got improved We reevaluated her :-

Diagnostic cystoscopy = moderate bladder trabeculation , mild trigonites

UDS =OAB +sever pelvic floor hyper mobility
Mod. Recto cell + Mod cystocele
Gynecologist asked me to repeat TOT And Ap repair +Ditropan

6 weeks after the operation she fell 80% better

What will happen after 4-5 years And what about OAB??

3
CASE #2
 Ms.N

42 year old not married presented with irritative luts And urge incontinence
For more than 20 years

O/E normal

Diagnosed 7 years ago as idiopathic detrusor over activity

She took many medication with wax of wane

All her blood investigations are normal

Since 4 years ago there was no medication that can help her
Advised to have Botox, But refused

Now she is convinced to do partial cystectomy with augmentation cystoscopy

5
CASE #3
 Ms.N

72 year old lady with difficulty of micturition post void dribbling and mild
obstractive symptoms

O/E = mild supra pubic tenderness

PmH= HT+DM since many years and controlled

Cystoscopy =mild trabiculation. + mild trigonitis

UDS = mild deutroser underactivity

Mild sphincter weakness

Management ?

Bethanicol

7
CASE #4
 Ms.N

A 78 year Old Lady presented with irritative luts and urge incontinence
For 3 years

O/E no relevant history

PMHx= DM controlled

pSHX = negative

GUE = recurrent UTI , normal rft

UDS= OAB

Shall we give anticholinergics or risk cognitive dysfunction consequence?

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 • A double blind, randomized, placebo controlled, single dose, crossover,
exploratory study to compare the safety of SolifenaCin and Oxybutynin
with Placebo on cognitive function in Elderly healthy subjects

Wesnes, et al. J. Expert Opinion on Drug Safety

8(6): 615-626 (2009)

Wesnes et al , J. Expert Opinion on Drug Safety 8(6): 615-626 (2009) 34

Scope Study Abstract

• Vesicare 10mg did not show any evidence for an ability to impair
cognitive function in a healthy elderly population1
• This is consistent with its bladder tissue selectivity and greater affinity
for the M3 versus M1 receptor1

• Evaluation of the Vesicare data at 6 hours post-dose (Tmax) did not

show any indication of possible impairment1

• The evaluation of oxybutynin 10mg at 2 hours produced the

predicted impairments to information processing, learning and
memory, which were also evident in subjects’ self-ratings of
alertness1
• This is consistent with the known PK and pharmacodynamic profile of
the compound1

Wesnes et al , J. Expert Opinion on Drug Safety 8(6): 615-626 (2009) 34