The road to the rise of great doctors

Chapter 50 "Using yourself laughing" is sometimes a disease
Liu Dong has seen many patients in the Department of Urology who have "difficulty urinating or difficulty urinating". He has never seen an example of this "counterexample" of urinating too easily, and the information he knows is only the classification of urinary incontinence in textbooks. test points, as well as a short paragraph on treatment principles and methods.

So, my interest increased greatly after seeing it.

He looked through the medical records and learned about the situation with Shan Jiajia, who asked about the medical history at the time.

This is a woman who has passed retirement age. She has given birth to 3 children naturally. She has been leaking urine for 6 years. She will leak urine every time she coughs or laughs. In the past year, she has started to have frequent urination and frequent urination. acute aggravation.

In the past, there was no obvious leakage of urine when lying down or not moving. There was only leakage after coughing, laughing, and physical activity. It was still bearable at that time.But then the amount of urine leakage increased, and even in the past year, the situation has changed. I feel like something is about to fall out. Although I leak urine, I feel a little laborious when I consciously urinate, and I still feel that I can't urinate. Clean, and repeated frequent and urgent urination.This was really unbearable for her!

The patient initially went to a clinic and pharmacy, where she was given some anti-inflammatory drugs, which sometimes worked but sometimes did not.

This time, she no longer went to clinics and pharmacies. Instead, she spent her savings and went to the largest hospital in the province - the Affiliated Hospital of Medical College - with her husband.She thought this must be a serious illness.

After coming here, I had a few chats with the outpatient doctor and was recommended to the Department of Urology. Then, under the assignment of the outpatient nurse of the Urology Department, I went to Deputy Chief Dr. Li Nan, who has extensive knowledge in neurourology.After asking about the medical history, doing a physical examination, and doing a urine flow rate test, the diagnosis was initially made.

Consider diagnosing mixed urinary incontinence (stress urinary incontinence + urge urinary incontinence). The cause of something falling out from below is pelvic floor prolapse.

The prevalence of urinary incontinence in women gradually increases with age; the number of births and the mode of delivery are also related. The more births, the higher the incidence of urinary incontinence, and natural childbirth is more likely to cause urinary incontinence.Pelvic prolapse is also a common cause of stress urinary incontinence, but severe pelvic floor prolapse can reduce existing stress urinary incontinence symptoms and even cause difficulty urinating, urge or filling incontinence.

After Li Nan had a preliminary chat with the patient in the outpatient clinic, the patient felt relieved and made an appointment for hospitalization. She hoped to be able to solve the problem that had been bothering her for 6 years. They are all psychologically tortured.

While awaiting hospitalization, the patient continued to make appointments for urodynamic testing and swab testing, which confirmed the diagnosis.

After that, Li Nan first gave symptomatic treatment with drugs to control the symptoms of urinary urgency, and then observed changes in urine leakage.Because of mixed urinary incontinence, which one should be determined first?If stress urinary incontinence is the main problem, stress urinary incontinence should be treated first; if urge urinary incontinence is the main problem, urge urinary incontinence should be treated first.That's the purpose of drugs.

After taking the medication, the patient's symptoms and frequency of urinary urgency or urge urinary incontinence were significantly relieved.Therefore, the treatment plan is basically determined: surgery to treat the cause and stress urinary incontinence, and medication to control urge incontinence.Check again every 1 month after treatment to determine whether to adjust the plan.

After Liu Dong learned about it, he felt that neurourology is still a relatively mysterious field, or that it is related to "nerves" and is more or less obscure.

In addition to this, Liu Dong also listened to some complaints and concerns from Shan Jiajia, as well as the "unfairness" of women's genetics.He looked into Shan Jiajia's eyes, and while listening, he occasionally nodded to show that he was serious and that he was listening.

But in fact, Liu Dong filtered out invalid information and grasped the diagnostic key points and risk factors of urinary incontinence.After Shan Jiajia finished complaining, Liu Dong comforted her and said: "As age increases, men will also have urination problems. Isn't the most common thing this month is prostate hyperplasia? Do you remember the chief resident physician at that time? When doing popular science, it was said that prostatic hyperplasia is a benign disease, but as you age, the degree of hyperplasia will worsen. Whether you have difficulty urinating and the degree of difficulty in urinating depends entirely on God's will - whether the protruding part of the hyperplasia affects urination. At that time The words he said, 'Male compatriots, as you get older, you will fall into my hands sooner or later!' It's terrible."

"Both men and women have a lot of troubles in this area."

After a pause, he continued to persuade Shan Jiajia: "Even if there is, it is better to have treatment than to have no solution. Moreover, not everyone is like this. Besides, it is not a matter of getting married or not. It’s not certain if you want to have children after getting married, most of the children in the city only need one treasure, and children may not be born naturally, you think about it a bit early.”

When he saw that Shan Jiajia's mood had improved a little and her expression had turned gloomy, he continued to output the knowledge he had learned and said, "There is another trick that can be avoided or mitigated. You haven't returned it to the teacher, have you?"

"Kegel exercises! They are pelvic floor muscle training. To put it simply, they are contractions of the levator ani muscles. They can be done in two ways: a short and fast way and a long and slow way."

"The short and fast way requires us to quickly contract the sphincter and then relax it quickly, and then repeat the action."

"The long and slow way is to last for three to five seconds during contraction and the same for three to five seconds after relaxation, and do it about ten to twenty times each time."

"The two methods can be carried out alternately. We also need to learn how to do it. On the one hand, we can maintain health care ourselves, and on the other hand, we can help patients or friends when they need it."

After Shan Jiajia finished listening, she rolled her eyes at Liu Dong.Said: "You are quite good at coaxing girls, are you interested in me? Huh, I don't want to find a colleague. I'm in the hospital all day long, and I don't have much interest."

After hearing this, Liu Dong quickly handed over his hands and said: "I don't dare, I don't dare. Please let me go. I don't have this idea. You have to be careful about the other two people, hahahaha."

"Find a fight."

The two quickly separated and continued to work.Or ask about the patient's condition, read feedback on the report sheet, etc.Or study and compare the differences in treatment with disease knowledge chapters in books and other books.

Medical life can be boring sometimes, just like life, speaking of it, life is dull.However, there are always waves in the ordinary, and sometimes there may be big waves coming. These are all random events of fate. All we can do is face them well and show the extraordinary side in the ordinary.

everyone is unique.Medicine also maintains "fairness" amidst all kinds of unfairness. Even if it sometimes fluctuates, the vows made back then will ring out in due course.
(End of this chapter)