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Abstract: A 77-year-old male patient recently presented with abnormal urination, accompanied by abdominal distension and abdominal pain, and the patient was relatively distressed and mentally unwell. The patient was diagnosed with bladder dysfunction, i.e., urinary retention and bilateral hydronephrosis, through examination. After a brief description of the patient’s condition with the patient and his family, it was agreed to perform surgical cystostomy under anesthesia for treatment, and postoperative anti-infective medication was given. After active treatment, the patient’s urinary retention was significantly relieved, and he was discharged with good examination indicators and no significant abnormalities.
[Basic information] Male, 77 years old
Type of disease】Bladder dysfunction (urinary retention)
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of consultation】February 2021
Treatment plan】Surgery (cystostomy) + medication (cephalexin sodium for injection, amoxicillin sodium for injection)
Treatment period】13 days of hospitalization
Effectiveness】After treatment, the patient’s urinary retention improved significantly, and her basic signs were normal. The cystostomy tube and drainage bag showed clear, yellowish urine.
I. Initial consultation
I saw an older male patient in the morning who entered the clinic slowly with the help of his family. I briefly questioned the old man and learned that he had visited our hospital a year ago for prostate enlargement, but did not follow the doctor’s orders for systematic treatment due to his other special circumstances. On general examination, he was found to have a turbid zone on percussion with pressure pain in the bladder area, and the bladder was considered to be full due to urinary retention. The results suggested prostatic hyperplasia with urinary retention and hydronephrosis in both kidneys. He was admitted to the hospital because of the need for inpatient treatment.
II. Treatment process
The patient was initially diagnosed with prostatic hyperplasia and urinary retention based on the ultrasound findings and clinical symptoms. In addition, the family members were asked to accompany the patient for PSA (prostate-specific antigen) testing, because PSA is present in the prostate epithelium and is tissue-specific, so it is important to rule out prostate cancer and to determine whether there are nodules in the prostate or determine the texture of the nodules. The results showed that the total prostate-specific antigen was 13.61 ng/ml, which was significantly higher than the normal value. The patient is also considered to have the possibility of prostate cancer because of his age.
However, considering that the PSA test value may be affected due to inflammation and operational factors such as transurethral, pathology was prescribed to clarify the diagnosis. After repeatedly communicating with the family about the need for transprostatic puncture pathology, the family refused to perform further pathology examinations considering the patient’s advanced age as well as his poor general condition and the high cost of treatment after diagnosis. After I communicated with the family and signed an undertaking, the family agreed to perform a cystostomy to permanently drain the urine and avoid further urinary retention. The cystostomy was performed under local anesthesia, and the whole operation went smoothly and took about 30 minutes. After the operation, anti-inflammatory treatment was administered intravenously with cefonicid sodium for injection and amoxicillin sodium for injection to avoid infection.
III. Treatment effect
After 13 days of hospitalization, the patient’s urinary retention improved significantly and disappeared. The patient is now in good general condition, with a normal appearance. He reported no abdominal pain, abdominal distension, appetite or sleep abnormalities, and his stool is normal.
IV. Notes
I was very pleased to see the patient discharged from the hospital.
1. post-operative treatment with anti-inflammatory drugs should be actively followed by medical advice. if there is allergy to the drug due to oneself, it is recommended to stop using the drug immediately and inform the doctor.
2, after the operation should ensure that the fistula at the hygiene and clean, according to medical advice to regularly wipe, disinfection treatment and regular replacement, so as not to induce infection resulting in fever and other situations.
3, pay attention to maintain a good sleep posture and habits, so as to avoid excessive activity that may lead to cystostomy tube prolapse.
V. Personal insight
Urinary retention is usually caused by the presence of bladder or prostate diseases that lead to difficulty in urination. This patient has a large amount of urine in the bladder due to urinary retention, resulting in abdominal distension and other symptoms, which is more painful, and the presence of prostatic hyperplasia is clear after examination, which does not exclude the possibility of cancer. The actual fact is that you should actively improve your diet and avoid eating spicy and stimulating foods to avoid local stimulation leading to inflammatory diseases. It is advisable to avoid holding your urine to avoid overfilling the bladder and causing the bladder sphincter to become incompetent, and to avoid being sedentary and drinking more water to promote urination.
The doctor’s point of view is that if cancer is suspected, pathological examination should be performed in a timely manner to clarify the diagnosis and actively treat the disease to promote its regression, but for older people aged 77 years, taking into account their actual situation and the wishes of their families, if further pathological examination is performed to confirm the diagnosis of prostate cancer, it may cause unnecessary damage to patients and their families, so the ultimate solution is to improve the symptoms of elderly patients and improve the quality of life. The ultimate solution is to improve the symptoms and quality of life of elderly patients.