Academic day 13/02/2014 MUBARAK ALKABEER HOSPITAL

A 55 years old Kuwaiti lady Admitted through urology OPD C/O frequency. Next? Case #1

Present hx Started 6 months back Severe dysuria, frequency and hematuria. Passed small fragment with the urine 4 months back. Not associated with loin pain, fever or nausea Not known as a stone former Next?

Medical history PMH : Nill PSH : tension-free vaginal tape one year ago by gynecologist. Was complaining from stress incontinence. Not on any medication. 3 daughters all by normal vaginal delivery. Next?

Examination Afebrile Vitally stable Unremarkable examination Next?

Labs Urine R/M : RBC /mm3 WBC >200 /mm3 PH 6-5 Urine C/S CBC & RFT : All within the normal range Next?

KUB

CT KUB

2x3x1 cm calcification (stone) is noted in the right side of the urinary bladder away from VUJ. Adjacent wall thickening with minimal surrounding fat stranding suggestive of chronic inflammatory changes. Next?

Cystoscopy was done showing the finding on the right lateral wall of UB.

Diagnosis Intravesical mesh erosion related to the use of the TVT sling with stone formation.

Case #2 A 76 years old gentleman Complaining of severe dysuria and frequency. Next?

3 days history of severe dysuria, frequency and fever. Gave a history of mild weak stream and frequency. Nocturia History of previous AUR 2 months ago. Next?

No past medical or surgical history Not on any medication No history of stone disease Non smoker Next?

Examination T 39.2 BP 150/85 HR 91 Abdomen was soft, not tender. DRE : moderate enlarged prostate, tender. No nodules. Next?

Labs CBC : WBC 13.6 Hb 134 RFT : Within normal range Urine R/M (dipstick) ++WBC, +RBC Next?

Started on Amikacin 1g IV OD and Rocephin 1g IV OD Ultrasound Urine & Blood culture Next?

U/S Pelvis 70 cc prostate Pre void 260 ml Post void 60 Next?

2 nd day morning in the hospital the patient was shivering temperature was 39C Pulse 120 BP 120/70 Perfalgan 1 gm IV was given. Next day morning his temperature was 38.4 Next?

Antibiotic shifted to Meropnem 1g IV/8h Vital signs monitoring Repeat CBC, RFT and trace cultures Next?

Urine C/S : No growth Blood culture : No growth Next:?

TRUS

TRUS without biopsy Prostate volume is 98 cc Multiple hypo-echoic areas of different sizes involving peripheral and central zones. Suggested of collection. Aspiration done around 35 ml Sample sent for culture

The other day, patient spiked fever of 39C + rigors at night. Low grade fever persist after aspiration Next?

CT ABD with IV contrast

Multiple Prostatic abscesses Largest 4x3 cm Next?

2 nd drainage done 25 cc aspirated Continued on meronem Was doing well, no fever for 3 days Went home on Septrin