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Academic day 13/02/2014MUBARAK ALKABEER HOSPITAL
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A 55 years old Kuwaiti lady Admitted through urology OPDC/O frequency.
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Case #1
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Present hx Started 6 months backSevere dysuria, frequency and hematuria.Passed small fragment with the urine 4 months
back.Not associated with loin pain, fever or nauseaNot known as a stone former
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Medical historyPMH : NillPSH : 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.
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ExaminationAfebrileVitally stableUnremarkable examination
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Labs Urine R/M : RBC 100-150 /mm3WBC >200 /mm3PH 6-5Urine C/S CBC & RFT : All within the normal range
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KUB
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CT KUB
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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.
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Cystoscopy was done showing the finding on the right lateral wall of UB.
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DiagnosisIntravesical mesh erosion related to the use
of the TVT sling with stone formation.
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Case #2A 76 years old gentlemanComplaining of severe dysuria and frequency.
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3 days history of severe dysuria, frequency and fever.
Gave a history of mild weak stream and frequency. NocturiaHistory of previous AUR 2 months ago.
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No past medical or surgical historyNot on any medicationNo history of stone disease Non smoker
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ExaminationT 39.2BP 150/85HR 91Abdomen was soft, not tender.DRE :
moderate enlarged prostate, tender. No nodules.
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LabsCBC :WBC 13.6Hb 134RFT :Within normal rangeUrine R/M (dipstick)++WBC, +RBC
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Started on Amikacin 1g IV OD and Rocephin 1g IV OD
UltrasoundUrine & Blood culture
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U/S Pelvis70 cc prostatePre void 260 mlPost void 60
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2nd day morning in the hospital the patient was shivering
temperature was 39CPulse 120BP 120/70Perfalgan 1 gm IV was given.Next day morning his temperature was 38.4
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Antibiotic shifted to Meropnem 1g IV/8hVital signs monitoringRepeat CBC, RFT and trace cultures
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Urine C/S : No growthBlood culture : No growth
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TRUS
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TRUS without biopsy Prostate volume is 98 ccMultiple hypo-echoic areas of different sizes
involving peripheral and central zones. Suggested of collection.
Aspiration done around 35 mlSample sent for culture
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The other day, patient spiked fever of 39C + rigors at night.
Low grade fever persist after aspiration
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CT ABD with IV contrast
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Multiple Prostatic abscessesLargest 4x3 cm
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2nd drainage done25 cc aspirated Continued on meronemWas doing well, no fever for 3 daysWent home on Septrin