A Cortico-Neurocentric Approach to LUTS

NY Vesicocentric Vesicocentric thinking thinking ¾ ¾ Bladder thought to be autonomous or reflexive Bladder thought to be autonomous or reflexive ¾ ¾ Bladder size is too small Bladder size is too small ¾ ¾ Isolated de novo detrusor problems Isolated de novo detrusor problems ¾ ¾ UTI UTI' 's due to bladder lining problems or poor s due to bladder lining problems or poor hygeine hygeine ¾ ¾ Bowel pushes up against the bladder and Bowel pushes up against the bladder and decreases capacity decreases capacity ¾ ¾ Accidents are due to immaturity of the brain Accidents are due to immaturity of the brain Evolution to a Evolution to a Cortico Cortico-Neurocentric Neurocentric Theory Theory ¾ ¾ Anticholinergics didn Anticholinergics didn' 't work for everyone t work for everyone z z Some kids got better for a brief period and Some kids got better for a brief period and then became worse then became worse z z Some kids never had any response Some kids never had any response z z Children with ADD/ADHD had little or no Children with ADD/ADHD had little or no response to Anticholinergics response to Anticholinergics ¾ ¾ Biofeedback didn Biofeedback didn' 't work for all and did little t work for all and did little for urgency problems for urgency problems Evolution to a Evolution to a Cortico Cortico-Neurocentric Neurocentric Theory: Our experience Theory: Our experience ¾ ¾ Pts with bulbar urethritis that had OAB Pts with bulbar urethritis that had OAB responded to hytrin responded to hytrin ¾ ¾ We began using hytrin to treat OAB We began using hytrin to treat OAB ¾ ¾ Tegaserod was used for constipation and the Tegaserod was used for constipation and the patients responded with a improvement in patients responded with a improvement in constipation but also an elimination of constipation but also an elimination of pvr pvr ¾ ¾ Pts who responded to Botox A injections for Pts who responded to Botox A injections for ESD did not have elimination of OAB symptoms ESD did not have elimination of OAB symptoms with specific treatment with specific treatment Evolution to a Neurocentric Theory: Evolution to a Neurocentric Theory: Our experience Our experience ¾ ¾ Many patients would respond with Many patients would respond with elimination of the OAB symptoms when elimination of the OAB symptoms when treated for underlying Neuropsychiatric treated for underlying Neuropsychiatric problems …