5. History of present illness
• Started to pass urine frequently during day i.e. 3-4 times
within an hour
• Woke up 3-4 times at night to pass urine
• Insidious and gradually progressive
• Inability to hold urine once he had desire to pass it
• Also soiled his undergarments
6. • Had to strain to start act of micturation
• Associated with thinning of stream followed by passage of
urine in drops wetting his undergarments
• Bladder was not completely empty
7. Past History
• Hemorrhoidectomy 30 years back
• Right inguinal hernioplasty 25 years back
• No history of trauma, instrumentation
• No history of Tuberculosis, Diabetes and HTN
8. Allergy History
• Not allergic to known food and drugs.
Family History
• No history of similar illness in the family
• No history of TB, DM and HTN in family members
9. Personal History
• Mixed diet
• Occasional drinker
• Left smoking 8 years back (used to smoke 20 pack year)
10. On Examination
• General condition
– Conscious, co-operative, well oriented to time, place and
person . No signs of respiratory distress.
• No evidence pallor, icterus, lymphadenopathy, clubbing,
cyanosis, oedema and dehydration.
• Vitals: Within normal limits
11. Systemic Examination
• Per abdominal:
Soft, non-tender
Approx. 5*3 cm2, non- tender, reducible buldge seen in left
inguinal region on straining, cough impulse positive
Bowel sound present
12. • Per rectal examination:
Smooth , rubbery swelling can be felt anteriorly in Rectum
Rectal mucosa can be freely moved over it
• Respiratory system: Bilaterally clear
• Cardiovascular system: first and second heart sound heard, no
murmur
13. Investigations
• Blood examination
• CBC- Within Normal limits
• Serology- Non reactive
• PT-INR: 1
• Ultarasonography (2074-11-29)
• Thickened and irregular urinary bladder wall
• Grade I prostatomegaly
14. • Uroflowmerty
Voided volume 124 ml
Max flow rate 5 ml/s
Avg. flow rate 2 ml/s
Post voidal residual volume 180 ml
• Cystoscopy
Trilobar enlargement
Some trabeculations with multiple saccules
16. Management
• Surgical procedure: Transurethral resection of prostate
Spinal Anesthesia on 2074-12-23.
OT Findings
• Moderately enlarged prostate
• Severe trabeculations with saccules
21. Etiology:
Theories
1. Hormonal
• Due to imbalance between androgen and estrogen
• Androgen level falls with increasing age but fall in
estrogen level is not equal
23. Clinical Features:
• Urgency, Hesitency, Nocturia
• Overflow and terminal dribbling
• Difficulty in micturation with weak stream and dribble
• Acute retention of urine
• Tenderness in suprapubic region
• Feartures of UTI
• DRE: Enlarged prostate
24. Lower urinary tract symptoms (LUTS)
Symptoms of voiding:
• Hesitency
• Poor flow
• Intermittent stream- stops and starts
• Dribbling
• Sensation of poor emptying of bladder
• Episodes of near retention
25. Symptoms of storage
• Frequency
• Nocturia
• Urgency
• Urge incontinence
• Nocturnal incontinence
31. Management:
1. Conservative
• Wait and watch
• Urethral Catheterisation
• Spurapubic Cystostomy
• Correction of serum electrolytes
• Drugs:
o Alpha adrenergic blocker: Prazosin, Tamsulosin
o 5 alpha reductase inhibitor: Finasteride
32. 2. Surgery
Indications :
• Prostatism (frequency, urgency, dysuria)
• Acute retention of urine
• Chronic retention of urine with residual urine more than
200 ml
• Complications like hydroureter, hydronephrosis, recurrent
infection, stone formation
33. Surgery Options
a. Conventional surgical options
i. Transurethral resection of prostate (TURP)
ii. Retropubic prostatectomy (Millin’s)
iii. Transvesical prostatectomy (Freyer’s)
iv. Perineal prostatectomy (Young’s)
34. b. Minimally invasive therapy
i. Laser therpy: Using Holmium
ii. Transurethral needle ablation of prostate
iii. Microwave hyperthermia with temp. of 45-50degree
iv. Prostatic urethral stents
v. Transurethral dilatation of prostate
36. 2. Systemic
a. Cardiovascular and pulmonary:
Atelectasis, pneumonia, myocardial infarction,
congestive cardiac failure, Deep vein thrombosis
b. Water intoxication (TURP syndrome)
Absorption of water leading to congestive cardiac
failure, hyponatremia and hemolysis.
37. Refrences
• Hamilton Bailey and McNeill Love.(2012) Bailey and Love’s
SHORT PRACTICE of SURGERY. 26th Edition. New York:
CRC Press
• Sriram Bhat M. (2013) SRB’s MANUAL OF SURGERY. 4th
Edition. New Delhi: Jaypee Brothers Medical Publishers
