Mr. Gobindo Ghosh, a 74-year-old farmer from Nepal, presented with increased urinary frequency, poor urinary stream, and urgency for 1 year. Examination found an enlarged, smooth, firm prostate. Tests showed elevated prostate size on ultrasound and normal bloodwork. The diagnosis was benign prostatic hyperplasia. He was counseled on lifestyle changes and prescribed medications to manage his symptoms.
3. Particulars of the patient
• Name: Mr. Gobindo Ghosh
• Age: 74 years
• Sex: Male
• Marital status: Married
• Nationality: Nepali
• Religion: Hindu
• Occupation: Farmer
• Address: Gorkha, Central Nepal.
• Date of Admission: 15-10-2019
• Date of Examination: 16-10-2019
4. Chief complaints
• Increase frequency of micturition for 1 year
• Poor stream for 1 year
• Urgency for last 6 months
5. History of presenting illness
• According to the statement of the patient, he was
apparently well 1 year back. Then he noticed increased
frequency of urine. It was insidious in onset, and
gradually progressive up to 12 to 14 times a day
without increasing water intake.
• There is history of poor stream which exaggerated on
straining. It was sometimes followed by passage of few
drops of urine in his undergarments.
6. • There was also history of inability to hold urine
once the urge initiates. On few occasions he had
soiled his clothes due to inability to hold the urine
before rushing for micturition. Sometimes, he had
trouble starting the urination as well.
• There was no history of blood in urine, trauma,
instrumentation or surgery of urinary tract.
7. • Patient did not mention about fever, reduced appetite
and there is no H/O involuntary loss of weight.
• His bowel habit is normal.
• He is normotensive and non-diabetic.
• He did not take any medication for above medical
conditions.
• Now he is admitted to the hospital for better
management.
17. • Clubbing: Absent
• Koilonychia: Absent
• Leukonychia: Absent
• Blood pressure: 150/110 mm of Hg
• Pulse: 95 beats/minute
• Respiratory rate: 22 breath/min
• Temperature: Normal
• Lymph node enlargement: Not enlarged
• JVP: Not raised
18. Abdominal examination
o On Inspection, shape of abdomen was normal, all quadrants
moving equally with respiration. No dilated veins, scar marks,
pigmentation, visible peristalsis was present. There was no
abnormal mass.
o On Palpation, there was no local rise in temperature and
tenderness was absent on superficial and deep palpation.
o On Percussion, each quadrant had tympanic note
&
o On auscultation, normal bowel sounds were present.
19. • There was no swelling in loin and renal angle.
Kidneys and bladder were not palpable.
20. Per Rectal examination
Prostate Examination:
oA swelling was palpated with smooth surface,
firm rubber like consistency, non tender with
deepened median sulcus and lateral grooves.
oMobility of rectal mucosa was not restricted.
oOther findings of digital rectal examination were
within normal limits.
21. Respiratory system examination
oOn, Inspection, no visible deformity, scar marks,
dilated veins were present.
oOn Palpation, no tenderness, abnormal mass was
present. Trachea was central in position.
oPercussion note was resonant.
oOn Auscultation, B/L equal air entry with no added
sounds.
24. Salient features
Mr. Gobindo Ghosh, 74 years old farmer, hailing from Gokhra,
Central Nepal, was admitted in the hospital with the complaints
of increase frequency of micturition for 1 year, poor stream for
same duration and urgency for last 6 months.
According to the statement of the patient, he was reasonably
well 1 year back. Then he noticed increased frequency of
urine. It was insidious in onset, and gradually progressive up
to 12 to 14 times a day without increasing water intake.
25. There is also history of poor stream which exaggerated on straining.
It was sometimes followed by passage of few drops of urine in his
undergarments.
There was also history of inability to hold urine once the urge
initiates. On few occasions he had soiled his clothes due to inability
to hold the urine before rushing for micturition. Sometimes, he had
trouble starting the urination as well.
He is normotensive and non-diabetic.
He is a smoker with a history of 25 pack years and consumes 1-2
glass of locally made alcohol daily for last 45 years.
26. According to IPSS (International Prostate Scoring System), from the
history, his score is 18.
He was non-anemic, non-icteric, there was no H/O weight loss. Edema,
dehydration was absent. His blood pressure was 150/110 mm of Hg,
pulse 95 beats/minute and respiratory rate 22 breath/min.
On prostate examination, a swelling was palpated with smooth surface,
firm rubber like consistency, non tender with deepened median sulcus
and lateral grooves. And mobility of rectal mucosa was not restricted.
Other system examination revealed no abnormalities.
31. Bio-chemistry:
• Random glucose= 77mg/100 mL
• Creatinine = 0.9/100 mL
• Na+= 132 mmol/L
• K+= 4.2 mmol/L
• Urine R/E was within normal limits
• Ultrasound revealed Grade II enlargement of prostate
33. Management
Patient was counseled about the condition and probable
need for surgery for the same condition.
Drugs prescribed:
• Tablet Nifedipine 10 mg PO stat
• Capsule Tamsulosin 0.4 mg OD for 1 month
• Tablet Finasteride 5 mg OD for 1 month
34. Advice
• Quit smoking and limit alcohol intake
• Minimization of Salt intake (WHO: <5 g/1 teaspoon of salt
a day, no added salt, avoid more salty and spicy food)
• Daily BP monitoring at local pharmacy and follow up
• Decreasing fluid intake in the evening
• Limiting diuretic products including alcohol and caffeine
• Double voiding to empty the bladder more completely
