80 yr old male with hematuria, nocturnal, dysuria, urge incontinence and uncontrolled sugars
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80 year old male has come to urology opd with c/o :
Nocturia since 2 months
Poor urinary stream since 2 months
Urge incontinence since 2 months
Hematuria since 3 days
Dysuria since 1 day
Patient was apparently alright 2 years ago, then he developed acute urinary retention. He was catheterised and is on foley’s since then.
Since 2 months, he developed nocturia.
Poor stream +
Dribbling +
Urgency +
Urge incontinence +
Hematuria since 3 days + Not associated with passage of clots
Dysuria since 1 day +
No h/o turbiduria
No h/o fever , vomiting , nausea
No h/o loss of weight , loss of appetite
H/o voiding trial given 5 months back and failed. He was advised surgery but the patient refused.
He was referred to general medicine i/v/o uncontrolled sugars secondary to non compliance to medication with carcinoma bladder , benign prostatic hyperplasia and urinary tract infection.
Past history :
K/c/o DM since 3 years and is on medication (Tab Metformin 500 mg + Glimiperide 2 mg PO/OD)
K/C/O HTN since 1 year and is on medication (Tab Telma 20 mg PO/OD)
N/k/C/o epilepsy, asthma, CAD, thyroid disorders.
Personal history :
Sleep : adequate
Diet : mixed
Appetite : normal
Bowel and bladder : regular
Addictions : smoking - sutta since the age of 16. (7-8 per day)
Consumes alcohol (90ml) occasionally
General examination:
Pt is conscious, coherent and cooperative
No pallor , icterus , cyanosis, clubbing, lympadenopathy, edema
Vitals :
PR: 78 bpm
RR: 14 cpm
BP: 120/70 mmHg
GRBS : 256 mg/dl
Systemic examination :
CVS : S1 S2 heard no murmurs
RS : BAE NVBS heard.
P/A : soft non tender
No free fluid.
CNS : No FND
Local Examination :
External genitalia normal
B/L direct hernia +
P/R - Grade 2 Prostatomegaly +
16 Fr foley’s in situ
Hematuria in urobag
Investigations :
ECG :
Ultrasonography :
Treatment :
TAB OFLOX 200 mg PO/BD
TAB PAN 40 mg PO/OD
SYP ALKASTON 15 ml in 1/2 glass of water PO/BD
TAB TAMSULOSIN-D PO/HS
INJ HAI 8 IU SC TID
INJ NPH 6 IU SC TID
TAB GLIMICUT M2 PO/OD
SYP POTKLOR 15 ml PO/TID
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