Post on 16-Jan-2016
description
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: BPHCa prostateStone bladder or urethraNeurogenic bladderDrug inducedUrethral 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