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