- 1. OAB Real life Cases
- Dr Clarence Lei Chang Moh, FRCS Urol
- Consultant Urologist, Kuching
- 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 @
- - 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!!
4. What Ix?
- 1. Urine FEME (RM13) or culture(RM45)
- 5. Uroflow most GH in UK, urologist,see
5. What Ix?
- 2. PSA - 0.38; 0.32 (2.3.10)
6. 7. TREATMENT
- Tolterodine 2 mg bd, physicians(PTCA 2009)
- 3. Resign from some boards
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)
- - flow st good, full bladder
9. What Ix?
- 3. Ultrasound urinary tract (N?)
- 5. Bladder volume (20 cc)
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
- ? 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/
- Urology/CL: 8.6.2001- Urgency, UUI
- PMH: TUR prostate abscess 18.4.98 (PSA 14)
- Stone op: RK, S pore 98, ESWL, London, SJMC
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
- 4. TRUS: 25 cc hypoechoic areas both
18. PROGRESS: PSA problem
- 2.4.02 - No prostatitis, suspicious
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
20. 21. Dato Seri AHL, DOB 1933 (76 yrs)
- ED, DM, HBP, PTCA @ SGH 12/05
22. What Ix GP?
23. What Ix Specialist?
- 1. Ultrasound urinary tract ?
- 2. Transrectal ultrasound ?
- 5. Uroflow and bladder scan, max. 19.3 ml/s
24. Management
- Anti-cholinergic bd, N Med Spec Ctre
25. What Next?
- 2. TRUS (14.8.09, 21.7.10: N)
26. Antibiotics for Prostate
27. Prostatitis
- 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 !