1. OAB Real life Cases

• Dr Clarence Lei Chang Moh, FRCS Urol

Consultant Urologist, Kuching

[email_address]

BORNEO REGIONAL UROLOGY WORKSHOP,

Kota Kinabalu, 9-10 July 2011

2. Tan Sri BN (DOB: 1938); 72 yrs HBP, IHD, ( PTCA 2004 SJMC ), gout, psoriasis, IBS

Urology/CL: 23.10.99 (65 yrs)

- Urgency with episode UUI @

Board Meeting

- Freq 2H, but N 1x

- Flow good, no pain, no H

wants some medication, important meeting

Nursing Assessment BP: 187/103

3. Further Mx

Examine pt?History usu sufficient

DRE: uncomfortable for dr & pt!!

Any Ix ??

or just give Vesicare??

4. What Ix?

1. Urine FEME (RM13) or culture(RM45)

2. PSA who need PSA?

3. U/S UT any evidence ?

4. TRUS urologist

5. Uroflow most GH in UK, urologist,see

5. What Ix?

1. Urine - N

2. PSA - 0.38; 0.32 (2.3.10)

3. U/S UT - Normal

4. TRUS - 30 mls

5. Uroflow - see

6. 7. TREATMENT

Tolterodine 2 mg bd, physicians(PTCA 2009)

2. Tolterodine 2 mg PRN

3. Resign from some boards

4. ? CVS

OAB:Vesicare (+ PDE5I + Nebido) 8. CCY, corporate pay, DOB: 1932, 78 yrs

IHD, AAA 5.4 cm., colonic polyps, spine op, ED

Urology/CL 27.7.04- urgency

(72yrs)- frequency 2-4 hrs (MahJ)

- N 2-4x

- flow st good, full bladder

BP: 190/98, HR: 80

DRE: Normal

9. What Ix?

1. Urine FEME, C&S (N?)

2. PSA (1.91?)

3. Ultrasound urinary tract (N?)

4. TRUS (37.5 cc?)

5. Bladder volume (20 cc)

6. Uroflow (see tracing)

10. Comment on Uroflow:. 11. 12. UROFLOW IS typical of . Patient says flow is GOOD, IPSS vs QOL 13. TREATMENT

Tolterodine SR 4 mg? Risk AUR

? 2. Alfuzosin XL 10 mg

? 3. Dutasteride 0.5 mgWHO NEEDS IT?

? 4. PDE5 I ? Which one? Corporate pay

TRIPLE meds: TKH,HAJ, MA, OBC DOUBLE: LTT 14. 15. Mr DS, DOB: 1925, 84 yrs

LBP/R THR / analgesic. CRF, creat 229/cataracts/

colonic polyps

Urology/CL: 8.6.2001- Urgency, UUI

(75yrs)- Nocturia 3x

- Good flow

PMH: TUR prostate abscess 18.4.98 (PSA 14)

Stone op: RK, S pore 98, ESWL, London, SJMC

bladder SGH 1980.

DRE: Normal

16. Any more tests or just give Vesicare?? Does he need the uroflow?? 17. What Ix?

1. Urine: Protein 2+, C&S: Neg.

2. US: BK echogenic with cysts, RK LP

stone 14 mm

3. PSA: 24.5 (22.8.2001)

4. TRUS: 25 cc hypoechoic areas both

5. Uroflow: see tracing

18. PROGRESS: PSA problem

PSA raised 30: biopsies

4.98 - biopsies prostate

2.4.02 - No prostatitis, suspicious

2.9.03 - PSA 40

19. TREATMENT ?

Anti-cholinergics (tds, then OD): No money!

(since 10.6.2001, esp long flights)

Prostate biopsy 23.10.03: Ca P (3+3) both

3 monthly FU, sc Zoladex last 17.11.09

PSA 10.6.01: 0.56

20. 21. Dato Seri AHL, DOB 1933 (76 yrs)

ED, DM, HBP, PTCA @ SGH 12/05

Urology/CL: 10.10.2001

Day 1 - 2 hr, N 4 - 5x

Seen GP London

DRE: normal

22. What Ix GP?

1.Urine FEME

2. Urine FEME, C&S

3. Blood BS BUSE

4. Blood BS BUSE PSA

23. What Ix Specialist?

1. Ultrasound urinary tract ?

2. Transrectal ultrasound ?

4. Cystoscopy??

5. Uroflow and bladder scan, max. 19.3 ml/s

24. Management

OAB

Anti-cholinergic bd, N Med Spec Ctre

GH since 10.10.01!

FOLLOW-UP:

25. What Next?

1. Follow-up - ? 6 mthly

2. TRUS (14.8.09, 21.7.10: N)

3. TRUS Biopsy

4. If (+), what next?

5. Urine FEME, C&S

26. Antibiotics for Prostate

Types

duration

27. Prostatitis

Urine leuco(+), C&S Neg.

23.10.09 - Ofloxacin 200 mg bd x 1 month

21.07.10 - Doxycycline 100 mg bd x 1 month

Antibiotics: SS, K, RT 28. Thank you !