V poradn\u011b \u010cesk\u00e9ho rozhlasu Plze\u0148 se v\u011bnujeme hodn\u011b intimn\u00edmu probl\u00e9mu, tedy inkontinenci, \u00faniku mo\u010di a to s doktorem Martinem Hav\u00ed\u0159em, z urogynekologick\u00e9 poradny Gynekologicko-porodnick\u00e9 kliniky Fakultn\u00ed nemocnice Plze\u0148.<\/p>\n
moder\u00e1tor:
\nco to tedy p\u0159esn\u011b inkontinence je?<\/p>\n
Martin HAV\u00cd\u0158,
\nInkontinence je vlastn\u011b p\u0159\u00edznak, nejedn\u00e1 se o samotnou nemoc, ale p\u0159\u00edznak, kdy si pacient st\u011b\u017euje na jak\u00fdkoliv v\u016fl\u00ed nekontrolovateln\u00fd \u00fanik mo\u010di.<\/p>\n
moder\u00e1tor:
\nKoho nej\u010dast\u011bji postihuje?<\/p>\n
Martin HAV\u00cd\u0158,
\nRozvrstven\u00ed ve spole\u010dnosti je stejn\u00e9 jak u mu\u017e\u016f, tak u \u017een, samoz\u0159ejm\u011b se stoupaj\u00edc\u00edm v\u011bkem se \u010detnost nebo \u010detnost tohoto p\u0159\u00edznaku, \u010detnost t\u00e9to poruchy zvy\u0161uje.<\/p>\n
moder\u00e1tor:
\nP\u0159esto pom\u011brn\u011b \u010dasto mi p\u0159ijde, \u017ee sl\u00fdch\u00e1me, \u017ee se t\u00fdk\u00e1 sp\u00ed\u0161e \u017een, tak\u017ee v praxi tomu tak nen\u00ed, je to opravdu p\u016fl na p\u016fl?<\/p>\n
Martin HAV\u00cd\u0158,
\nAsi to bude opravdu p\u016fl na p\u016fl, samoz\u0159ejm\u011b j\u00e1 ze sv\u00e9 praxe zn\u00e1m pouze pacientky, tak\u017ee nedok\u00e1\u017eu \u00fapln\u011b p\u0159esn\u011b \u0159\u00edct, jak \u010dasto to b\u00fdv\u00e1 u mu\u017e\u016f, ale \u0159\u00edk\u00e1 se, \u017ee zhruba je to stejn\u011b jak u mu\u017e\u016f, tak u \u017een.<\/p>\n
moder\u00e1tor:
\nM\u016f\u017eete bl\u00ed\u017ee popsat, z jak\u00fdch p\u0159\u00ed\u010din k tomu \u00faniku mo\u010di doch\u00e1z\u00ed?<\/p>\n
Martin HAV\u00cd\u0158,
\nrozezn\u00e1v\u00e1me dva z\u00e1kladn\u00ed typy \u00faniku mo\u010di. Prvn\u00ed je stresov\u00fd typ inkontinence, kdy doch\u00e1z\u00ed k \u00faniku na z\u00e1klad\u011b zv\u00fd\u0161en\u00ed nitrob\u0159i\u0161n\u00edho tlaku p\u0159i ka\u0161li, k\u00fdchnut\u00ed, sm\u00edchu a tlak v b\u0159i\u0161e p\u0159es\u00e1hne ten uz\u00e1v\u011brov\u00fd tlak v mo\u010dov\u00e9 trubici a doch\u00e1z\u00ed k okam\u017eit\u00e9mu \u00faniku mo\u010di. Ten druh\u00fd typ, tomu \u0159\u00edk\u00e1me takzvan\u00fd hyperaktivn\u00ed mo\u010dov\u00fd m\u011bch\u00fd\u0159, d\u0159\u00edve se tomu \u0159\u00edkalo urgentn\u00ed inkontinence, a jedn\u00e1 se o \u00fanik, kter\u00fd je prov\u00e1zen neovladateln\u00fdm pocitem nucen\u00ed na mo\u010den\u00ed, kdy pacient nesta\u010d\u00ed dob\u011bhnout na toaletu a dojde k \u00faniku.<\/p>\n
moder\u00e1tor:
\nJak, jak\u00fdm zp\u016fsobem m\u016f\u017eeme za\u010d\u00edt \u0159e\u0161it?<\/p>\n
Martin HAV\u00cd\u0158,
\nT\u011bch \u0159e\u0161en\u00ed je v\u00edce. Z\u00e1vis\u00ed na typu inkontinence, pacientka, kdy\u017e k n\u00e1m p\u0159ich\u00e1z\u00ed, tak my provedeme kompletn\u00ed vy\u0161et\u0159en\u00ed ultrazvukov\u00e9 urodynamick\u00e9 a na z\u00e1klad\u011b t\u011bchto v\u00fdsledk\u016f potom nab\u00eddneme pacientce \u0159e\u0161en\u00ed, samoz\u0159ejm\u011b ka\u017ed\u00fd typ t\u00e9 inkontinence m\u00e1 sv\u016fj typ \u0159e\u0161en\u00ed a my m\u00e1me komplexn\u00ed \u0161k\u00e1lu, jak\u00fdm zp\u016fsobem pacientce pomoci.<\/p>\n
moder\u00e1tor:
\njsem se do\u010detl, \u017ee inkontinence m\u016f\u017ee b\u00fdt jak vlhk\u00e9, tak st\u0159edn\u00ed, tak v t\u011b\u017ek\u00e9 form\u011b, jestli byste to mohl bl\u00ed\u017ee popsat?<\/p>\n
Martin HAV\u00cd\u0158,
\nAno. Jedn\u00e1 se sp\u00ed\u0161e o subjektivn\u00ed vn\u00edm\u00e1n\u00ed, m\u016f\u017ee b\u00fdt pacientka, kter\u00e1 m\u00e1 trval\u00fd \u00fanik mo\u010di a nevn\u00edm\u00e1 to jako n\u011bjak\u00fd velk\u00fd probl\u00e9m, m\u016f\u017ee b\u00fdt mlad\u00e1 pacientka, kter\u00e1 m\u00e1 \u00fanik mo\u010di jednou do t\u00fddne a vn\u00edm\u00e1 to jako z\u00e1sadn\u00ed probl\u00e9m, chce \u0159e\u0161it.<\/p>\n
moder\u00e1tor:
\nJe n\u011bco, co \u010dlov\u011bk m\u016f\u017ee ud\u011blat v oblasti prevence?<\/p>\n
Martin HAV\u00cd\u0158,
\nPrevence je v tomhle p\u0159\u00edpad\u011b velmi obt\u00ed\u017en\u00e1. D\u00e1 se \u0159\u00edct, \u017ee p\u0159\u00ed\u010dinou t\u00e9 stresov\u00e9 inkontinence mo\u010di b\u00fdv\u00e1 porucha statiky p\u00e1nevn\u00edho dna, a\u0165 je to d\u00e1no prod\u011blan\u00fdmi porody, operacemi, v\u011bkem, kdy doch\u00e1z\u00ed ke zhor\u0161en\u00ed kvality vazivov\u00e9ho apar\u00e1tu, ale m\u016f\u017ee to b\u00fdt zp\u016fsobeno i jin\u00fdmi p\u0159\u00ed\u010dinami, nap\u0159\u00edklad infekc\u00ed v mo\u010dov\u00e9m m\u011bch\u00fd\u0159i a tak d\u00e1l. V podstat\u011b se d\u00e1 \u0159\u00edct, \u017ee ur\u010ditou prevenci b\u00fdv\u00e1 dostate\u010dn\u00fd pitn\u00fd re\u017eim, to znamen\u00e1, nen\u00ed \u0159e\u0161en\u00edm to, \u017ee kdy\u017e m\u00e1m \u00fanik mo\u010di, \u017ee nebudu p\u00edt, t\u00edm p\u00e1dem budu m\u00e9n\u011b mo\u010dit a t\u00edm p\u00e1dem nebudu chodit \u010d\u016frat, naopak, ten probl\u00e9m to m\u016f\u017ee zhor\u0161ovat.<\/p>\n
moder\u00e1tor:
\nJak \u010dasto \u0159e\u0161\u00edte pr\u00e1v\u011b ty situace, kdy pacientky omez\u00ed pitn\u00ed re\u017eim, \u0159e\u0161\u00ed to \u010dasto pr\u00e1v\u011b t\u00edmto zp\u016fsobem?<\/p>\n
Martin HAV\u00cd\u0158,
\n\u0158e\u0161\u00ed to velmi \u010dasto a v podstat\u011b to m\u016f\u017ee zp\u016fsobovat takov\u00fd ten za\u010darovan\u00fd kruh, proto\u017ee t\u00edm, \u017ee se produkuje m\u00e9n\u011b mo\u010di, ta mo\u010d b\u00fdv\u00e1 koncentrovan\u00e1, dr\u00e1\u017ed\u00ed mo\u010dov\u00fd m\u011bch\u00fd\u0159, a naopak to \u010dast\u011bj\u0161\u00ed \u010d\u016fr\u00e1n\u00ed odplavuje v podstat\u011b bakterie, kter\u00e9 se zvl\u00e1\u0161\u0165 u \u017een m\u016f\u017eou snadno do toho mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e dostat, tak\u017ee omezov\u00e1n\u00ed p\u0159\u00edjmu tekutin nen\u00ed \u0159e\u0161en\u00ed.<\/p>\n
moder\u00e1tor:
\nCo jim v tu chv\u00edli tedy doporu\u010dujete jako alternativn\u00ed \u0159e\u0161en\u00ed?<\/p>\n
Martin HAV\u00cd\u0158,
\nAlternativn\u00ed \u0159e\u0161en\u00ed z\u00e1vis\u00ed na v\u00fdsledc\u00edch v t\u011bch proveden\u00fdch vy\u0161et\u0159en\u00edch. M\u00e1me konzervativn\u00ed mo\u017enosti l\u00e9\u010dby, to znamen\u00e1, posilov\u00e1n\u00ed svalu p\u00e1nevn\u00edho dna, to znamen\u00e1 cvi\u010den\u00ed, m\u016f\u017eeme pou\u017e\u00edt farmakologick\u00e9 postupy, to znamen\u00e1 l\u00e9\u010dbu, kterou po vy\u0161et\u0159en\u00ed zah\u00e1j\u00edme. m\u00e1me i opera\u010dn\u00ed \u0159e\u0161en\u00ed, ale v\u0161echno toto z\u00e1vis\u00ed na tom typu t\u00e9 inkontinence nebo typu toho probl\u00e9mu, kter\u00fd pacientka m\u00e1.<\/p>\n
poslucha\u010dka:
\nTady poslucha\u010dka z Klatovska. j\u00e1 bych m\u011bla takov\u00fd dotaz, moje p\u0159\u00edbuzn\u00e1, je j\u00ed 50 let, m\u00e1 takov\u00fd probl\u00e9m, jednak chod\u00ed \u010dasto, jednak m\u00e1 \u00fanik p\u0159\u00edmo, \u017ee to neudr\u017e\u00ed a cht\u011bla bych se zeptat, jestli je mo\u017en\u00e9, \u017ee se tvo\u0159\u00ed tolik mo\u010de, kdy\u017e chod\u00ed tak \u010dasto a jestli ten \u00fanik dost velk\u00fd nem\u016f\u017ee m\u00edt n\u011bjak\u00fd takov\u00fd vliv, \u017ee unik\u00e1 n\u011bjak\u00fd ten miner\u00e1l, t\u0159eba drasl\u00edk a tak d\u00e1le.<\/p>\n
Martin HAV\u00cd\u0158,
\nTak ur\u010dit\u011b ta mo\u010d je po\u0159\u00e1d stejn\u00e1, neunikaj\u00ed \u017e\u00e1dn\u00e9 miner\u00e1ly, \u017e\u00e1dn\u00fd drasl\u00edk, tak\u017ee z toho si pacientka v\u016fbec starost d\u011blat nemus\u00ed. Podle toho, co \u0159\u00edk\u00e1, velmi pravd\u011bpodobn\u011b se u n\u00ed jedn\u00e1 o ten hyperaktivn\u00ed mo\u010dov\u00fd m\u011bch\u00fd\u0159, to znamen\u00e1, \u017ee chod\u00ed \u010dasto \u010d\u016frat, ale ty porce t\u00e9 mo\u010di jsou mal\u00e9, tak\u017ee ve fin\u00e1le vy\u010d\u016fr\u00e1 stejn\u011b jako pacientka, kter\u00e1 by chodila \u010d\u016frat \u00fapln\u011b norm\u00e1ln\u011b v norm\u00e1ln\u00edm intervalu. My pova\u017eujeme v podstat\u011b \u010dast\u011bj\u0161\u00ed nucen\u00ed, to znamen\u00e1, v\u00edce ne\u017e osmkr\u00e1t za den u\u017e za p\u0159\u00edznak hyperaktivn\u00edho mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e, kter\u00fd prim\u00e1rn\u011b ur\u010den t\u011bmi urgencemi,\u00a0 to je to \u010dast\u00e9 a nekontrolovateln\u00e9 nucen\u00ed k mo\u010den\u00ed, kter\u00e9 b\u00fdv\u00e1 prov\u00e1zeno \u010dast\u00fdm mo\u010den\u00edm, \u010d\u016fr\u00e1n\u00edm v noci a \u010dasto b\u00fdv\u00e1 zhruba tak v jedn\u00e9 t\u0159etin\u011b prov\u00e1zeno i t\u00edm urgentn\u00edm \u00fanikem mo\u010di, to znamen\u00e1 \u00fanikem, ne\u017e ta pacientka sta\u010d\u00ed dob\u011bhnout na toaletu.<\/p>\n
moder\u00e1tor:
\nNo, a v t\u011bch okam\u017eic\u00edch, \u017ee ona d\u00e1ma u\u017e tu mo\u010d neudr\u017e\u00ed, je schopna se je\u0161t\u011b n\u011bjak sv\u00e9pomoc\u00ed nebo u\u017e doporu\u010dujete tak jako tak nav\u0161t\u00edvit l\u00e9ka\u0159e.<\/p>\n
Martin HAV\u00cd\u0158,
\nNe, mysl\u00edm si, \u017ee sv\u00e9pomoc\u00ed to pacientky \u0159e\u0161\u00ed pr\u00e1v\u011b t\u00edm zm\u00edn\u011bn\u00fdm omezov\u00e1n\u00edm p\u0159\u00edjmu tekutin, ale sama u\u017e si pomoci asi nedok\u00e1\u017ee, doporu\u010dil bych j\u00ed nav\u0161t\u00edvit na\u0161i ambulanci, kde prob\u011bhne\u00a0 vy\u0161et\u0159en\u00ed a my j\u00ed navrhneme n\u011bjakou l\u00e9\u010dbu.<\/p>\n
moder\u00e1tor:
\nP\u0159\u00edpadn\u011b m\u00e1 to \u010dlov\u011bk br\u00e1t p\u0159es praktick\u00e9ho l\u00e9ka\u0159e, od kter\u00e9ho dostane pak n\u00e1sledn\u011b doporu\u010den\u00ed ke specialistovi?<\/p>\n
Martin HAV\u00cd\u0158,
\nP\u0159esn\u011b tak. K n\u00e1m chod\u00ed pacientky vlastn\u011b s doporu\u010den\u00edm, m\u011bl by to b\u00fdt bu\u010f i obvodn\u00ed gynekolog, anebo praktick\u00fd l\u00e9ka\u0159. A na z\u00e1klad\u011b tohoto doporu\u010den\u00ed pak se objedn\u00e1 na vy\u0161et\u0159en\u00ed.<\/p>\n
poslucha\u010d:
\nPros\u00edm v\u00e1s, poslucha\u010d z Plzn\u011b, j\u00e1 m\u00e1m takov\u00fd probl\u00e9m, u\u017e asi 5 let se l\u00e9\u010d\u00edm na prostatu, loni mi bylo jako doporu\u010deno vybrou\u0161en\u00ed t\u00fd prostaty, j\u00e1 jsem to absolvoval a od t\u00fd doby p\u016fl roku to bylo v po\u0159\u00e1dku, te\u010f se mi to zhor\u0161ilo rapidn\u011b a nav\u00edc taky m\u00e1m \u00fanik t\u00fd mo\u010di, nev\u00edm, co s t\u00edm m\u00e1m d\u011blat.<\/p>\n
Martin HAV\u00cd\u0158,
\nTak samoz\u0159ejm\u011b j\u00e1 jsem urogynekolog, tak\u017ee co se t\u00fd\u010de inkontinence u mu\u017e\u016f, tak to nen\u00ed \u00fapln\u011b p\u0159esn\u011b m\u016fj obor, nicm\u00e9n\u011b doporu\u010dil bych v\u00e1m nav\u0161t\u00edvit sv\u00e9ho urologa, informovat ho o t\u011bchto probl\u00e9mech a na z\u00e1klad\u011b t\u011bch zji\u0161t\u011bn\u00ed, jestli se jedn\u00e1 teda o \u00fanik p\u0159i stresu, to znamen\u00e1, zv\u00fd\u0161en\u00ed nitrob\u0159i\u0161n\u00edho tlaku, anebo jestli je to zase to nucen\u00ed prov\u00e1zen\u00e9 \u00fanikem, ur\u010dit\u011b v\u00e1m navrhne n\u011bjakou l\u00e9\u010dbu, je pravda, \u017ee v posledn\u00ed dob\u011b m\u00e1me spoustu nov\u00fdch prepar\u00e1t\u016f, kter\u00e9 se u\u017e\u00edvaj\u00ed jednou denn\u011b a maj\u00ed velmi dobr\u00e9 \u00fa\u010dinky p\u0159i mnohem ni\u017e\u0161\u00edm po\u010dtu ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f, ne\u017e to bylo u prepar\u00e1t\u016f, kter\u00e9 se u\u017e\u00edvaly v minulosti.<\/p>\n
moder\u00e1tor:
\nKdy\u017e u\u017e se bav\u00edme o konkr\u00e9tn\u00edch mo\u017enostech boje s inkontinenc\u00ed, jak velkou roli p\u0159ikl\u00e1d\u00e1te t\u011bm zmi\u0148ovan\u00fdm cvi\u010den\u00edm, je to \u00fa\u010dinn\u00e1 metoda p\u0159i zvl\u00e1d\u00e1n\u00ed t\u011bch leh\u010d\u00edch forem.<\/p>\n
Martin HAV\u00cd\u0158,
\nSamoz\u0159ejm\u011b, \u017ee to \u00fa\u010dinn\u00e1 metoda sv\u00fdm zp\u016fsobem je, u t\u011bch leh\u010d\u00edch forem posilov\u00e1n\u00ed svalu p\u00e1nevn\u00edho dna m\u00edv\u00e1 efekt, ale vy\u017eaduje to, aby ta pacientka nebo ten pacient posiloval intenzivn\u011b a soustavn\u011b, to znamen\u00e1, prakticky ka\u017ed\u00fd den mus\u00ed posilovat, mus\u00ed cvi\u010dit 10, 15 minut denn\u011b, r\u00e1no \u2013 ve\u010der, pak se efekt m\u016f\u017ee dostavit. P\u0159i t\u011bch t\u011b\u017e\u0161\u00edch form\u00e1ch, to je stresov\u00e1 inkontinence, kter\u00e1 je prov\u00e1zena t\u0159eba se sestupem p\u00e1nevn\u00edch org\u00e1n\u016f, v\u011bkem, hormon\u00e1ln\u00ed dysbalanc\u00ed t\u0159eba v post menopauze, tak tam u\u017e ten \u00fa\u010dinek b\u00fdv\u00e1 omezen.<\/p>\n
moder\u00e1tor:
\nKdy\u017e \u010dlov\u011bk pot\u0159ebuje zjistit, jak spr\u00e1vn\u011b cvi\u010dit, kde se k takov\u00fdm informac\u00edm dostane?<\/p>\n
Martin HAV\u00cd\u0158,
\nMy pacientk\u00e1m p\u0159ed\u00e1v\u00e1m bro\u017eurky nebo DVD, kde uvid\u00ed p\u0159esn\u011b ten typ toho cvi\u010den\u00ed, samoz\u0159ejm\u011b m\u016f\u017ee pacientka nav\u0161t\u00edvit i fyzioterapeuta, kte\u0159\u00ed b\u00fdvaj\u00ed vzd\u011bl\u00e1ni v t\u011bch form\u00e1ch cvik\u016f p\u0159\u00edmo na konkr\u00e9tn\u00ed probl\u00e9m a m\u016f\u017ee z\u00edskat dan\u00e9 informace i na Internetu, kde v\u0161echno b\u00fdv\u00e1 dob\u0159e pops\u00e1no<\/p>\n
moder\u00e1tor:
\nJak\u00e9 mo\u017enosti dnes nab\u00edzej\u00ed medikamenty, u\u017e jste se p\u0159ed chvilkou zm\u00ednil o nov\u00fdch prepar\u00e1tech.<\/p>\n
Martin HAV\u00cd\u0158, :
\nTa medikament\u00f3zn\u00ed l\u00e9\u010dba je v podstat\u011b hlavn\u011b na probl\u00e9my hyperaktivn\u00edho mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e, na stresov\u00fd typ inkontinence je v\u00fdb\u011br omezen, existuj\u00ed r\u016fzn\u00e9 prepar\u00e1ty, ale jejich efekt nen\u00ed velmi dobr\u00fd a jsou tam ob\u010das i ne\u017e\u00e1douc\u00ed \u00fa\u010dinky, proto\u017ee prim\u00e1rn\u011b jsou to l\u00e9ky ur\u010den\u00e9 na n\u011bco jin\u00e9ho.<\/p>\n
poslucha\u010dka:
\nJ\u00e1 m\u00e1m na v\u00e1s takovou prosbu, pane doktore, j\u00e1 m\u00e1m kamar\u00e1dku, ta u\u017e asi 6 let trp\u00ed i bolestma a d\u011blali jste dv\u011b operace a nem\u016f\u017ee nikde pracovat, proto\u017ee nos\u00ed ty kalhotky a mus\u00ed, nebo se chod\u00ed \u010dasto p\u0159ebalovat, a to nen\u00ed nikde p\u0159\u00edjemn\u00fd, nebyla na \u017e\u00e1dn\u00fdm pracovi\u0161ti a ani nen\u00ed dostatek t\u011bch m\u00edst pro ty t\u011blesn\u011b posti\u017een\u00fd, v tomhle p\u0159\u00edpad\u011b teda. Co byste mi radil, aby ud\u011blala. Chod\u00ed k v\u00e1m na kontroly do nemocnice, ale v\u011bt\u0161inou v\u017edycky dostala antibiotika, kter\u00fd moc nepom\u00e1haly.<\/p>\n
Martin HAV\u00cd\u0158,:
\nTak rozum\u00edm tomu, \u017ee to je velk\u00fd probl\u00e9m, jsou pacientky, kter\u00e9 maj\u00ed velk\u00e9 pot\u00ed\u017ee a to \u0159e\u0161en\u00ed nep\u0159ich\u00e1z\u00ed, p\u0159esto\u017ee se sna\u017e\u00edme, j\u00e1 nev\u00edm, konkr\u00e9tn\u011b jak v tomto p\u0159\u00edpad\u011b, jak\u00e9 prod\u011blala operace, kv\u016fli \u010demu a pokud k n\u00e1m chod\u00ed, tak pevn\u011b v\u011b\u0159\u00edm tomu, \u017ee se j\u00ed sna\u017e\u00edme pomoc.<\/p>\n
poslucha\u010dka:
\nN\u011bjakou p\u00e1sku, nebo co, nev\u00edm, o co jde.<\/p>\n
Martin HAV\u00cd\u0158,
\nAno, ta p\u00e1ska, ta p\u00e1skov\u00e1 operace, spr\u00e1vn\u011b se to jmenuje tahu prost\u00e1 po\u0161evn\u00ed p\u00e1ska, v podstat\u011b typ operace, kdy zav\u00e1d\u00edme po\u0161evn\u00ed cestou kousek s\u00ed\u0165ky, prou\u017eek s\u00ed\u0165ky z nevst\u0159ebateln\u00e9ho materi\u00e1lu, kter\u00e9 se \u0159\u00edk\u00e1 p\u00e1ska a ta voln\u011b podep\u00edr\u00e1 mo\u010dovou trubici, tak\u017ee pacientka nebo i pacient se m\u016f\u017eou v p\u0159\u00edpad\u011b pot\u0159eby voln\u011b vy\u010d\u016frat, nic to neutiskuje, nic to nep\u0159itahuje, ale v p\u0159\u00edpad\u011b toho stresu, toho zv\u00fd\u0161en\u00ed nitrob\u0159i\u0161n\u00edho tlaku p\u0159i tom ka\u0161li, k\u00fdchnut\u00ed, doch\u00e1z\u00ed k tomu, \u017ee se mo\u010dov\u00e1 trubice o tu p\u00e1sku op\u0159e, stiskne, uzav\u0159e a k tomu \u00faniku v tom okam\u017eiku nedoch\u00e1z\u00ed. Samoz\u0159ejm\u011b b\u00fdvaj\u00ed komplikovan\u00e9 p\u0159\u00edpady, kdy se t\u0159eba tyhle dva typy inkontinence kombinuj\u00ed, \u0159\u00edk\u00e1me tomu sm\u00ed\u0161en\u00e1 inkontinence, kdy b\u00fdv\u00e1 ten stresov\u00fd typ doprov\u00e1zen\u00fd i t\u00edm urgentn\u00edm \u010dast\u00fdm mo\u010den\u00edm a pak\u00a0 ten probl\u00e9m b\u00fdv\u00e1 obt\u00ed\u017en\u011bji \u0159e\u0161iteln\u00fd, jsou i pacientky, u kter\u00fdch se p\u0159es ve\u0161kerou na\u0161i snahu efekt nedostavuje, nebo to zlep\u0161en\u00ed b\u00fdv\u00e1, ale nen\u00ed to dostate\u010dn\u00e9.<\/p>\n
poslucha\u010dka:
\nnem\u00e1 ani pen\u00edze, proto\u017ee nem\u016f\u017ee sehnat m\u00edsto a nem\u016f\u017ee ani d\u011blat, j\u00e1 nev\u00edm, co s t\u00edm teda, co bych j\u00ed \u0159ekla, jak, tak mohla by p\u0159ij\u00edt za v\u00e1mi, pane doktore?<\/p>\n
Martin HAV\u00cd\u0158,
\nUr\u010dit\u011b, a\u0165 p\u0159ijde, a\u0165 se obr\u00e1t\u00ed na m\u011b a pokus\u00edm se ji pomoci.<\/p>\n
poslucha\u010dka:
\ntady je\u0161t\u011b jin\u00fd v\u011bci k tomu, kter\u00fd se p\u0159ipojuj\u00ed, no, i nervy v \u010dudu, promi\u0148te to slovo, a \u017ee pro to nen\u00ed kolonka nikde …<\/p>\n
moder\u00e1tor:
\nPoji\u0161\u0165oven mysl\u00edte?<\/p>\n
poslucha\u010dka:
\nNo, vym\u011b\u0159en\u00e1, ano.<\/p>\n
Martin HAV\u00cd\u0158,
\nNo, je to p\u0159esn\u011b, jak \u0159\u00edk\u00e1te, inkontinence je velk\u00fd socioekonomick\u00fd probl\u00e9m, ti pacienti b\u00fdvaj\u00ed izolov\u00e1ni ze \u017eivota, ze spole\u010densk\u00e9ho \u017eivota a samoz\u0159ejm\u011b i m\u016f\u017eou p\u0159ij\u00edt kv\u016fli tomu o zam\u011bstn\u00e1n\u00ed, tak\u017ee to se v\u0161echno nabaluje a rozum\u00edm tomu, \u017ee to vn\u00edm\u00e1 negativn\u011b.<\/p>\n
moder\u00e1tor:
\nco jste schopni vy\u0159e\u0161it operac\u00ed, jak ten z\u00e1krok vypad\u00e1?<\/p>\n
Martin HAV\u00cd\u0158,
\nna\u0161e opera\u010dn\u00ed l\u00e9\u010dba ne\u0159e\u0161\u00ed pouze inkontinenci mo\u010di, ale \u0159e\u0161\u00edme komplexn\u00ed poruchy statiky p\u00e1nevn\u00edho dna, to znamen\u00e1, nejenom \u00fanik mo\u010di, ale i t\u0159eba sestup p\u00e1nevn\u00edch org\u00e1n\u016f. Pokud se budeme bavit o t\u00e9 inkontinenci mo\u010di, nej\u010dast\u011bj\u0161\u00ed operac\u00ed, kter\u00e1 dneska v podstat\u011b je zlat\u00fdm standardem v l\u00e9\u010db\u011b stresov\u00e9 inkontinence mo\u010di je takzvan\u00e1 tahu prost\u00e1 po\u0161evn\u00ed p\u00e1ska, je v\u00edc typ\u016f, v\u00edce v\u00fdrobc\u016f, ale v podstat\u011b d\u00e1 se \u0159\u00edct, \u017ee ka\u017ed\u00fd rok prov\u00e1d\u00edme tuto operaci v \u0159\u00e1du stovek a m\u016f\u017eeme \u0159\u00edct, \u017ee s t\u00edm m\u00e1me velmi dobrou zku\u0161enost, jak u n\u00e1s, tak celosv\u011btov\u011b, \u0159e\u0161\u00ed to v podstat\u011b 90 procent tohoto \u00faniku kompletn\u011b vy\u0159e\u0161\u00ed a m\u00e1me spokojen\u00e9 pacientky, kter\u00e9 odch\u00e1z\u00ed zp\u011bt do rukou sv\u00e9ho gynekologa.<\/p>\n
moder\u00e1to
\njak\u00e9 hygienick\u00e9 pom\u016fcky jsou v sou\u010dasn\u00e9 dob\u011b na trhu?<\/p>\n
Martin HAV\u00cd\u0158, :
\nSamoz\u0159ejm\u011b v\u00fdrobc\u016f je mnoho, pou\u017e\u00edvaj\u00ed se inkontinen\u010dn\u00ed vlo\u017eky, kter\u00e9 jsou nebo inkontinen\u010dn\u00ed kalhotky p\u0159i tom v\u011bt\u0161\u00edm stupni \u00faniku, kter\u00e9 jsou tro\u0161ku n\u011bco jin\u00e9ho ne\u017e menstrua\u010dn\u00ed vlo\u017eky, proto\u017ee pohlcuj\u00ed mo\u010d, kterou m\u011bn\u00ed v podstat\u011b na takov\u00fd gel a pohlcuj\u00ed i ten z\u00e1pach. P\u0159edpis t\u011bchto pom\u016fcek by m\u011bl b\u00fdt v\u017edycky v rukou bu\u010f obvodn\u00edho gynekologa, anebo praktick\u00e9ho l\u00e9ka\u0159e.<\/p>\n
moder\u00e1tor:
\nPan\u00ed Dana p\u0159ipsala i v\u011bk, 36 let, p\u00ed\u0161e: „Dobr\u00fd den, chci se zeptat, jestli jde k sob\u011b TVT p\u00e1ska a t\u011bhotenstv\u00ed. A je pak n\u011bjak\u00e9 omezen\u00ed?“<\/p>\n
Martin HAV\u00cd\u0158,
\n\u0159e\u0161en\u00ed u mlad\u0161\u00edch pacientek, zvl\u00e1\u0161\u0165 t\u0159eba po prod\u011blan\u00fdch porodech, ta p\u00e1ska b\u00fdv\u00e1, nen\u00ed vylou\u010deno t\u011bhotenstv\u00ed, ale je tady ur\u010dit\u00e9 omezen\u00ed, pokud by pl\u00e1novala dal\u0161\u00ed t\u011bhotenstv\u00ed po t\u00e9to operaci, doporu\u010dujeme porod c\u00edsa\u0159sk\u00fdm \u0159ezem, je to z toho d\u016fvodu, \u017ee ten n\u00e1sledn\u00fd porod po t\u00e9to p\u00e1sce m\u016f\u017ee omezit, anebo \u00fapln\u011b zru\u0161it efekt t\u00e9to operace, podle jedn\u00e9 studie snad a\u017e v 50 procentech byly pacientky po dal\u0161\u00edm porodu po p\u00e1sce op\u011bt inkontinentn\u00ed. Tak\u017ee v podstat\u011b dal\u0161\u00ed porod by m\u011bl b\u00fdt c\u00edsa\u0159sk\u00fdm \u0159ezem.<\/p>\n
moder\u00e1tor:
\nTVT p\u00e1ska, to je ta, o kter\u00e9 si ji\u017e del\u0161\u00ed dobu bav\u00edme.<\/p>\n
Martin HAV\u00cd\u0158,
\nAno.<\/p>\n
moder\u00e1tor:
\nDob\u0159e. „Je pro m\u011b l\u00e9k na stresovou inkontinenci, kdy\u017e m\u00e1m glaukom,“ pt\u00e1 se pan\u00ed L\u00edba.<\/p>\n
Martin HAV\u00cd\u0158, :
\nJak jsem ji\u017e \u0159\u00edkal, na stresovou inkontinenci l\u00e9ky nejsou, farmakologick\u00e9 l\u00e9ky, kter\u00e9 na to jsou, jsou, maj\u00ed men\u0161\u00ed efekt a m\u016f\u017eu m\u00edt v\u00fdrazn\u011bj\u0161\u00ed ne\u017e\u00e1douc\u00ed \u00fa\u010dinky, t\u0159eba na vysok\u00fd krevn\u00ed tlak a tak d\u00e1l, nicm\u00e9n\u011b glaukom je pro n\u00e1s omezen\u00ed sp\u00ed\u0161e p\u0159i t\u00e9 farmakologick\u00e9 l\u00e9\u010db\u011b, p\u0159i tom hyperaktivn\u00edm m\u011bch\u00fd\u0159i, pak je nutn\u00e9 vyj\u00e1d\u0159en\u00ed o\u010dn\u00edho l\u00e9ka\u0159e, jestli se jedn\u00e1 o glaukom s otev\u0159en\u00fdm nebo s uzav\u0159en\u00fdm \u00fahlem a podle toho my m\u016f\u017eeme p\u0159istoupit k l\u00e9\u010db\u011b<\/p>\n
moder\u00e1tor:
\nDal\u0161\u00ed dotaz: „Pane doktore, \u0159\u00edk\u00e1te, \u017ee v oblasti inkontinence nerozli\u0161ujete stupe\u0148 st\u0159edn\u00ed, t\u011b\u017ek\u00fd a tak d\u00e1le, jen\u017ee kdy\u017e m\u00e1 pak p\u0159ij\u00edt k pln\u011bn\u00ed ze strany poji\u0161\u0165oven, je to jinak, bohu\u017eel.“<\/p>\n
Martin HAV\u00cd\u0158,
\nNev\u00edm, co t\u00edm mysl\u00ed pacientka nebo t\u00e1zaj\u00edc\u00ed pln\u011bn\u00ed ze strany poji\u0161\u0165oven, my \u0159e\u0161\u00edme v na\u0161\u00ed poradn\u011b nebo na na\u0161\u00ed klinice ka\u017ed\u00fd \u00fanik mo\u010di, ka\u017edou pacientku, kter\u00e1 si st\u011b\u017euje, \u017ee m\u00e1 probl\u00e9m, my j\u00ed \u0159e\u0161\u00edme a poji\u0161\u0165ovna toto v\u017edycky bude hradit, nev\u00edm, jestli probl\u00e9m spo\u010d\u00edv\u00e1 v tom, \u017ee t\u0159eba praktick\u00fd l\u00e9ka\u0159 nechce p\u0159edepisovat hygienick\u00e9 pom\u016fcky, proto\u017ee pacientka ud\u00e1v\u00e1 jenom m\u00edrn\u00fd stupe\u0148 nebo st\u0159edn\u00ed stupe\u0148, samoz\u0159ejm\u011b, \u017ee to m\u016f\u017ee b\u00fdt probl\u00e9m, ale my \u0159e\u0161\u00edme ka\u017ed\u00fd stupe\u0148 a je jedno, jestli to je b\u011bhem dne nebo jednou za t\u00fdden.<\/p>\n
moder\u00e1tor:
\nTo znamen\u00e1, \u017ee i v p\u0159\u00edpad\u011b, \u017ee jde o leh\u010d\u00ed formy, nesetk\u00e1v\u00e1te ze strany poji\u0161\u0165oven s t\u00edm p\u0159\u00edstupem, \u017ee by to odm\u00edtli hradit.<\/p>\n
Martin HAV\u00cd\u0158,
\nNe, na na\u0161em pracovi\u0161ti, tak to ne\u0159e\u0161\u00edme.<\/p>\n
moder\u00e1tor:
\n„Pane doktore, tak\u00e9 jsem m\u011bla probl\u00e9m s \u00fanikem mo\u010di, l\u00e9ka\u0159ka mi \u0159ekla, \u017ee kdy\u017e zhubnu a budu cvi\u010dit p\u00e1nevn\u00ed cviky, \u017ee to odejde. Tak jsem zhubla 18 kilo a cvi\u010d\u00edm dodnes a jsem v po\u0159\u00e1dku.“<\/p>\n
Martin HAV\u00cd\u0158,
\nJe to p\u0159esn\u011b, jak jsem \u0159\u00edkal, mus\u00ed se cvi\u010dit soustavn\u011b a intenzivn\u011b a samoz\u0159ejm\u011b ta redukce hmotnosti m\u00e1 sv\u016fj smysl a vliv. Samoz\u0159ejm\u011b, \u017ee zase u star\u0161\u00edch pacientek to m\u016f\u017ee b\u00fdt velk\u00fd probl\u00e9m, proto\u017ee tam je za\u010darovan\u00fd kruh \u017eivotn\u00edho stylu, stravovac\u00edch n\u00e1vyk\u016f, fyzick\u00e9 kondice a tak d\u00e1l, tak\u017ee to zhubnut\u00ed m\u016f\u017ee b\u00fdt probl\u00e9m, je pravda, \u017ee obezita m\u016f\u017ee b\u00fdt i jednou z p\u0159\u00ed\u010din inkontinence mo\u010di.<\/p>\n
moder\u00e1tor:
\nPan\u00ed Jana p\u00ed\u0161e: „Dobr\u00fd den, m\u016f\u017ee inkontinence vzniknout zved\u00e1n\u00edm t\u011b\u017ek\u00fdch b\u0159emen, d\u00e1 se tomu p\u0159edej\u00edt n\u011bjak\u00fdm cvi\u010den\u00edm?“<\/p>\n
Martin HAV\u00cd\u0158,
\nSamoz\u0159ejm\u011b, \u017ee inkontinence m\u016f\u017ee vzniknout zved\u00e1n\u00edm t\u011b\u017ek\u00fdch b\u0159emen, doch\u00e1z\u00ed vlastn\u011b t\u00edm nadm\u011brn\u00fdm zvy\u0161ov\u00e1n\u00edm nitrob\u0159i\u0161n\u00edho tlaku k poru\u0161e statiky p\u00e1nevn\u00edho dna, k sestupu org\u00e1n\u016f, doch\u00e1z\u00ed k poklesu spodiny mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a toto m\u016f\u017ee b\u00fdt taky jedna z p\u0159\u00ed\u010din \u00faniku mo\u010di.<\/p>\n
moder\u00e1tor:
\nPoslucha\u010dka se ze Sokolova uv\u00e1d\u00ed: „Po operativn\u00edm odstran\u011bn\u00ed inkontinence trp\u00edm velmi \u010dast\u00fdmi z\u00e1n\u011bty mo\u010dov\u00fdch cest. Co s t\u00edm?“<\/p>\n
Martin HAV\u00cd\u0158,
\nJe to mo\u017en\u00e9, \u017ee ta operace m\u011bla n\u00e1sledek, \u017ee tam z\u016fst\u00e1v\u00e1 tro\u0161ku mo\u010di v mo\u010dov\u00e9m m\u011bch\u00fd\u0159i, u t\u00e9to pacientky bych ur\u010dit\u011b doporu\u010dil vyhledat l\u00e9ka\u0159e, podrobn\u011bj\u0161\u00ed vy\u0161et\u0159en\u00ed, jak u urodynamiky, tak t\u0159eba residu\u00e1ln\u00ed mo\u010di po vymo\u010den\u00ed ultrazvukem a vylou\u010dit n\u011bjakou mo\u017enou komplikaci, kter\u00e1 t\u0159eba nastala v souvislosti s tou operac\u00ed.<\/p>\n
moder\u00e1tor:
\nStihneme je\u0161t\u011b jeden dotaz, popros\u00edm o stru\u010dnost: „Jak\u00e9 jsou ochrann\u00e9 mo\u017enosti p\u0159i \u00faniku mo\u010di pro mu\u017ee?“<\/p>\n
Martin HAV\u00cd\u0158,
\nJak jsem ji\u017e \u0159\u00edkal, j\u00e1 jsem urogynekolog, tak\u017ee do t\u00e9 mu\u017esk\u00e9 problematiky tolik nevid\u00edm, ale samoz\u0159ejm\u011b bude tady platit to, \u017ee ten pacient by m\u011bl ur\u010dit\u011b nav\u0161t\u011bvovat pravideln\u011b urologa, m\u011bla by se mu kontrolovat prostata, jestli tam nedoch\u00e1z\u00ed ke zbytn\u011bn\u00ed. No, a pak se s n\u00edm domlouvat na n\u011bjak\u00fdm zp\u016fsobu l\u00e9\u010dby nebo prevence.<\/p>\n
moder\u00e1tor:
\nd\u011bkujeme, na shledanou.<\/p>\n","protected":false},"excerpt":{"rendered":"
V poradn\u011b \u010cesk\u00e9ho rozhlasu Plze\u0148 se v\u011bnujeme hodn\u011b intimn\u00edmu probl\u00e9mu, tedy inkontinenci, \u00faniku mo\u010di a to s doktorem Martinem Hav\u00ed\u0159em, z urogynekologick\u00e9 poradny Gynekologicko-porodnick\u00e9 kliniky […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":1645,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18],"tags":[],"class_list":["post-15812","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-poradna"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15812","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15812"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15812\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/1645"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15812"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}