(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A 78-year-old male patient with frequent, urgent, and painful urination for 3 years, and low urine volume per voiding, developed acute urinary retention six months ago, so he came to our hospital, and was diagnosed with prostatic hyperplasia combined with bladder stones after examination, and underwent transurethral electroprostatectomy, transurethral stone extraction, and intravenous amoxicillin sodium for injection, and his symptoms improved and his condition was stable after 1 week.
Basic Information】Male, 78 years old
Disease Type】Prostate enlargement
Hospital】Central South University Xiangya Hospital
Date of consultation】April 2022
Treatment plan】Surgical treatment (urethral electroprostatectomy, transurethral lithotomy) + medication (amoxicillin sodium for injection)
Treatment period】Inpatient treatment for 1 week, review after 1 month
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient complained of frequent urination, urgent urination, painful urination, increased nocturia, 5-6 times/night, occasional hematuria, thinner urine lines, shorter urination stroke, and less urine volume per urination, which was diagnosed as prostatic hyperplasia and bladder stone at the local hospital 3 years ago. The MRI examination showed an enlarged prostate with a maximum cross-sectional size of 48×45×42mm, mainly in the migratory zone and peripheral zone; the bladder wall was unevenly thickened, and a nodular iso-T1 slightly long T2 signal foci were seen in the bladder, with a size of about 20×17mm. The signal was low, and the ADC was slightly high in the corresponding area. The initial diagnosis was prostatic hyperplasia combined with bladder stones, and the patient was admitted to our department for treatment.
Treatment
After the patient was admitted to the hospital, the diagnosis of prostatic hyperplasia and bladder stones was clarified by completing relevant tests. The patient was given general anesthesia, ultrasound was used to crush the stones in the bladder, the urethra was dilated and the lumenoscope was placed to remove the stones, the electrolysis equipment was replaced, the prostate tissue was removed and taken out of the body, and the catheter was left in place after the operation and the patient was sent back to the ward. The patient was returned to the ward with a catheter for bladder irrigation and was given intravenous amoxicillin sodium for injection to control the development of inflammation and prevent infection.
III. Treatment effect
The patient showed increased urinary frequency, urgency, painful urination, increased nocturia and urinary retention before the surgical treatment. The imaging examination revealed an enlarged prostate volume and the presence of stones in the bladder. The patient was discharged from the hospital after 1 week of transurethral resection of the prostate and transurethral lithotomy, and the urination returned to normal without any abnormalities in urine volume, character and frequency. 1 month later, the patient returned to the hospital for follow-up examination and MRI, and the prostate size returned to normal and there were no stones in the bladder.
IV. Precautions
The patient’s discomfort was relieved by the treatment, and I was sincerely happy, while not forgetting to advise the patient to pay attention to the following points.
1. Pay attention to hydration and drink about 2000mL of water daily. In addition, it is recommended to drink more water during the day and less water before bedtime to avoid getting up at night after sleeping.
2, to develop good physical examination habits, it is recommended that the disease is stable after the annual prostate-related examination, pay attention to the progress of the disease.
3. The catheter should be left in place in the early postoperative period, and its position should be reasonably placed when moving around to avoid pulling and causing discomfort to the patient.
V. Personal insight
In this case, the patient’s symptoms were relieved after treatment and the prognosis was good. When reviewing the treatment process, I cannot help but reflect that the appearance of bladder stones may be related to prostatic hyperplasia, and that the patient’s low urine output per voiding over the past 3 years may cause a continuous increase in the amount of residual urine in the bladder, which in turn leads to the formation of stones. Considering this, the patient was once again told that he should pay close attention to the changes in his condition after discharge from the hospital, and that if there are any abnormalities such as reduced urine volume, frequency and urgency, he should seek medical attention in a timely manner to prevent the progression of prostate enlargement while also reducing the appearance of related conditions.