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Abstract: The patient in this case is a 71-year-old man who reported that for the past 3 years, he had urinary frequency, urgency, increased nocturia, and progressive difficulty in urination, including waiting for urination, incomplete urination, dripping urine, and occasionally hematuria. 1 day ago, he came to our hospital with difficulty in urination and lower abdominal cramping. The relevant laboratory as well as imaging tests were completed and urinary retention due to prostatic hyperplasia was considered. He was given indwelling catheterization + medication, and his condition has been controlled and his discomfort has improved significantly.
Basic information】Male, 71 years old
Disease Type】Prostate enlargement, urinary retention
Hospital】Beijing Anzhen Hospital, Capital Medical University
Date of Consultation】October 2021
Treatment plan] Indwelling catheterization + medication (Finasteride tablets, Serotoxin capsules)
Treatment period】Urinary catheter removed in 2 weeks, monthly outpatient follow-up
Treatment effect] The disease was significantly controlled, and the symptoms of discomfort were significantly improved, and no urinary retention occurred during the follow-up period.
I. Initial consultation
The patient came to our hospital with sudden onset of urinary retention, and reported that in the past 3 years, she began to experience frequent and urgent urination, an increase in the number of nocturnal urination, which was 5-6 times, and progressive difficulty in urination, including waiting for urination, incomplete urination, dripping urine, and occasionally hematuria. 1 day ago, she had difficulty in urination and lower abdominal swelling, so she came to our hospital for emergency treatment. The patient’s clinical symptoms were typical, and in this case, the first consideration was to solve the urination problem, i.e., to solve the symptoms of urinary retention, and an emergency indwelling catheter was chosen. At the same time, the relevant laboratory tests, as well as imaging examinations were improved. The laboratory tests include: routine blood, biochemistry, routine urine related to prostate tumor markers, and also urological ultrasound was performed to clarify the size and morphology of the prostate gland for any abnormalities and nodules, and also rectal examination of the prostate gland, which measured 5.6 cm x 5.2 cm x 4.5 cm. Combining the above tests, urinary retention due to prostate enlargement was considered.
(Urological ultrasound)
II. Treatment history
The patient was treated with an indwelling catheter in the emergency room, while for medication the general treatment was 5α-reductase inhibitors to improve obstructive symptoms, as well as 5α-reductase inhibitors to improve irritation, and α-blockers, including finasteride tablets and cycloidoxime capsules. Patients are advised to remove the urinary catheter after 2 weeks on an outpatient basis to observe urination. The use of finasteride tablets and selodosin capsules should be adhered to for a long period of time, and the condition should be reviewed regularly on a monthly basis on an outpatient basis to understand changes in the condition.
III. Treatment effect
The patient was able to urinate on his own after the catheter was removed and continued to take the medication. 1 month later, the patient reported that his urinary symptoms had improved and the number of nighttime urination had decreased to about 2, and the waiting time for urination and the urine line had changed. The patient did not experience urinary retention again and was resistant to surgery, so he chose to continue conservative treatment with medication and pay attention to lifestyle improvement, including avoiding sedentary reduction, spicy and stimulating foods, minimizing alcohol consumption, and continuing regular review. In conclusion, the patient’s condition has been significantly controlled and the discomfort has improved significantly, and no urinary retention occurred during the follow-up period. The patient expressed great satisfaction with the treatment.
IV. Notes
I am glad that the patient’s symptoms of urinary retention were relieved after treatment. For patients with prostatic hyperplasia, non-surgical treatment is the main treatment modality. This non-surgical treatment does not mean no intervention at all. The main attention is to provide health education to the patient, as well as to guide the patient’s lifestyle, take relevant medications, and regularly monitor some objective indicators of the patient, such as prostate volume, kidney function, and imaging ultrasound and CT of the urological system. Therefore, the patient is advised to seek medical follow-up if some clinical symptoms, such as recurrent urinary retention, renal insufficiency, concomitant bladder stones, recurrent hematuria, and other abnormalities, occur during the monitoring process. In daily life, improve your lifestyle, pay attention to rest, avoid staying up late, and eat a light, nutritious diet, avoiding spicy and stimulating food intake. Develop good urination habits and avoid holding urine.
V. Personal insight
The causes of urinary retention are complex, and some obstructive bladder outlet lesions, such as prostatic hyperplasia, tumor, stone, deformity, stenosis, and injury, are all causes of urinary retention. However, in this case of an elderly man with sudden urinary retention, the possibility of prostatic hyperplasia was first considered, and the obstruction needed to be removed to restore the patient’s urination. The patient should be relieved of the obstruction and restored to urination. Subsequently, relevant urological laboratory tests and imaging tests should be performed to rule out the possibility of other disorders. The treatment options for prostate enlargement usually include follow-up observation, medication, and in the event of serious complications, surgical treatment options can be considered.