Case 1 Urology Clinical Interactive Teaching Session

You are the intern on-call and was called to see a patient in the ER Good evening I am Dr. X What is your name?

Chief complaint: –Unable to pass urine. AUR VS Anuria. History of present illness: 55y old Duration=24h He has suprapubic pain.( Desire to micturate) For the last few months he noticed gradual decrease of his stream, hesitency, drippling Nocturia x 5, frequency q1.5h No dysuria or urgency.

Hematuria: –3m ago –Once –Total –No clots –No associated pain No no loin pain no fever

One episode of AUR following cholecystectomy about 4y ago. It was managed by in& out Foley catheter –Postoperative failure to pass urine Dehydration VS retention PMH: –Cystoscopy for stone bladder 10y ago. –UH repair many years ago –DM X 15y, remote CVA, Parkinson disease –No hypertension, IHD, Bilh., T.B. or Br.Asthma SI: –Low back pain

SH: –Widow and newly remarried. –Smokes 1ppd –Works in a tire shop  FH: Brother died of prostate disease.  Medication: ASA, Otrivin for common cold, buscopane, drug for his Parkinsonism  Drug Allergy:  Summery: 55y old male patient presented with 24h history of acute urinary retention

 DD:  BPH  Ca prostate  Stone bladder or urethra  Neurogenic bladder  Drug induced  Urethral stricture

Examination General: –Pain –Signs of Uremia –Pulse –BP –Temp Abdomen

SPT

 Examination: _General _In pain, pulse, BP, temp, _Look for signs of uremia –Abdomen: suprapubic area, loin, liver. –Back: No tenderness. –Genitalia: Hernia –PR: anal tone, size, consistency, surface, tenderness, mucosa.

Management: –Insert urethral catheter. –Suprapubic tube.

Investigations: –Urinanalysis, urine C&S.

C&S 1) Sensitivity 2) Safety 3) Costs 4) Oral or not 5) Frequency

–Renal profile: creatinine=189 –PSA= 8.8 –US: kidney pelvis TRUS –Urethrogram