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Abstract: Older men who have chronic difficulty urinating, a short-term bulge in the lower abdomen, and involuntary urine discharge should seek prompt medical attention for what may be chronic prostatic hyperplasia leading to overflow incontinence, often resulting in kidney function damage. The patient came to the hospital because he had been urinating frequently and not urinating for nearly 3 days, and was diagnosed with overflow urinary incontinence, and his symptoms were relieved after he was given a long-term indwelling cystostomy catheter.
Basic information】Male, 83 years old
Type of disease】Fulminant urinary incontinence
Hospital】Zhengzhou First People’s Hospital
Date of Consultation】December 2021
Treatment plan】Long-term indwelling cystostomy tube + medication (mirabellum extended-release tablets)
Treatment Period】10 days of hospitalization, 1 month of outpatient review
Treatment effect] Symptoms relieved, no other discomfort
I. Initial consultation
The patient was an 83-year-old male with dementia. On examination, the lower abdomen was bulging and urine was overflowing from the urethra when pressing on the lower abdomen. When the patient’s family was asked, they said that the patient had been experiencing frequent urination and dyspareunia in recent years, and had urinary retention three times during that period, and the catheter was removed after three days each time, and there had been no regular treatment. An emergency ultrasound examination was performed and the results were an enlarged prostate, 60 x 60 x 55 mm, 693 ml of residual urine in the bladder, the presence of bladder stones, bilateral hydronephrosis, and bilateral ureteral dilatation. The initial diagnosis was prostatic hyperplasia, urinary retention, and overflow incontinence. So the patient was admitted to the hospital.
II. Treatment process
The patient was admitted to the emergency department with an indwelling urinary catheter, and about 700 ml of yellowish urine was drained. The urodynamic examination showed that the patient’s bladder was not contracting, and he was given abdominal pressure to assist urination, and the urinary flow rate was 1 ml/s. Considering that the patient’s bladder was not contracting, and that he was of advanced age and had dementia, we decided to perform cystostomy and leave a cystostomy tube for long-term catheterization after communicating with his family.
III. Treatment results
After 3 days of long-term cystostomy catheterization, the patient’s renal function was rechecked and showed creatinine of 106 μmol/L and no further urinary incontinence. 10 days later, the patient was discharged for observation. One month after discharge, the renal function was rechecked and showed that the creatinine was 68 μmol/L. Ultrasound results showed no hydronephrosis in both kidneys and no dilatation of the ureters bilaterally. The patient was instructed to change the cystostomy tube regularly and monthly thereafter. During this period, the patient developed urinary leakage, which was considered to be caused by the irritation of the bladder wall by the cystostomy tube, and the leakage was relieved after oral administration of Mirabellum extended-release tablets. The patient also had intermittent hematuria, and the urine was seen to be light red. Considering the small amount of bleeding, no special treatment was done, and after the patient was advised to drink more water, the family indicated that the hematuria gradually subsided.
IV. Precautions
Happily, the patient recovered after treatment. However, since the patient was left with a cystostomy tube for a long time, he still needs to drink more water even after discharge to keep more urine volume to play the role of flushing the bladder and prevent urinary tract infection, bladder stone and blockage of the fistula due to low urine volume and concentrated urine.
Patients should drink water to thin the blood and prevent clots from filling the bladder and blocking the fistula. In addition, it is important for the patient’s family to take care of the cystostomy opening to prevent infection and crusting of the incisional secretions. The cystostomy tube should also be replaced regularly, usually once a month, and if it is not replaced for a long time, it is likely to increase the chance of infection and blockage, and if the drainage is not clear, it should be treated in the hospital.
V. Personal insight
Overflow incontinence is often a more advanced complication of prostatic hyperplasia. Increased bladder residual urine and high bladder pressure often cause damage to the kidneys and bladder, and in some patients, fluid retention in the abdomen and cardiopulmonary function. Most patients in this situation have no contraction of the bladder forcing muscles and can only solve the urination problem with a long-term indwelling cystostomy tube. Especially in elderly patients like the patient who have dementia and are bedridden for a long time, the bladder is unresponsive and often impairs kidney function or cardiopulmonary function before they can be detected and seen in time. Therefore, for elderly male patients who usually have recurrent urinary difficulties and develop urinary retention, early examination and treatment are recommended. Early treatment can solve the urinary problems by taking medication and surgery, which can also well protect kidney and cardiopulmonary functions, and can also effectively avoid long-term indwelling cystostomy tubes.