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Case presentation. Academic day 13/02/2014 MUBARAK ALKABEER HOSPITAL. Case #1. A 55 years old Kuwaiti lady Admitted through urology OPD C/O frequency. Next?. Present hx. Started 6 months back Severe dysuria, frequency and hematuria. Passed small fragment with the urine 4 months back.

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Case presentation

Case presentation

Academic day 13/02/2014

MUBARAK ALKABEER HOSPITAL


Case 1

Case #1

  • A 55 years old Kuwaiti lady

  • Admitted through urology OPD

  • C/O frequency.

  • Next?


Present hx

Present hx

  • Started 6 months back

  • Severe dysuria, frequency and hematuria.

  • Passed small fragment with the urine 4 months back.

  • Not associated with loin pain, fever or nausea

  • Not known as a stone former

  • Next?


Medical history

Medical history

  • PMH : Nill

  • PSH : tension-free vaginal tape one year ago by gynecologist. Was complaining from stress incontinence.

  • Not on any medication.

  • 3 daughters all by normal vaginal delivery.

  • Next?


Examination

Examination

Afebrile

Vitally stable

Unremarkable examination

Next?


Case presentation

Labs

  • Urine R/M :

    RBC 100-150 /mm3

    WBC >200 /mm3

    PH 6-5

  • Urine C/S

  • CBC & RFT :

    All within the normal range

    Next?


Case presentation

  • KUB


Case presentation

  • CT KUB


Case presentation

  • 2x3x1 cm calcification (stone) is noted in the right side of the urinary bladder away from VUJ.

  • Adjacent wall thickening with minimal surrounding fat stranding suggestive of chronic inflammatory changes.

  • Next?


Case presentation

  • Cystoscopy was done showing the finding on the right lateral wall of UB.


Diagnosis

Diagnosis

  • Intravesical mesh erosion related to the use of the TVT sling with stone formation.


Case 2

Case #2

  • A 76 years old gentleman

  • Complaining of severe dysuria and frequency.

  • Next?


Case presentation

  • 3 days history of severe dysuria, frequency and fever.

  • Gave a history of mild weak stream and frequency.

  • Nocturia

  • History of previous AUR 2 months ago.

  • Next?


Case presentation

  • No past medical or surgical history

  • Not on any medication

  • No history of stone disease

  • Non smoker

  • Next?


Examination1

Examination

  • T 39.2

  • BP 150/85

  • HR 91

  • Abdomen was soft, not tender.

  • DRE :

    • moderate enlarged prostate, tender.

    • No nodules.

    • Next?


Case presentation

Labs

  • CBC :

    WBC 13.6

    Hb 134

  • RFT :

    Within normal range

  • Urine R/M (dipstick)

    ++WBC, +RBC

    Next?


Case presentation

  • Started on Amikacin 1g IV OD and Rocephin 1g IV OD

  • Ultrasound

  • Urine & Blood culture

  • Next?


Case presentation

U/S Pelvis

  • 70 cc prostate

  • Pre void 260 ml

  • Post void 60

  • Next?


Case presentation

  • 2nd day morning in the hospital the patient was shivering

  • temperature was 39C

  • Pulse 120

  • BP 120/70

  • Perfalgan 1 gm IV was given.

  • Next day morning his temperature was 38.4

  • Next?


Case presentation

  • Antibiotic shifted to Meropnem 1g IV/8h

  • Vital signs monitoring

  • Repeat CBC, RFT and trace cultures

  • Next?


Case presentation

  • Urine C/S : No growth

  • Blood culture : No growth

  • Next:?


Case presentation

  • TRUS


Case presentation

  • TRUS without biopsy

  • Prostate volume is 98 cc

  • Multiple hypo-echoic areas of different sizes involving peripheral and central zones. Suggested of collection.

  • Aspiration done around 35 ml

  • Sample sent for culture


Case presentation

  • The other day, patient spiked fever of 39C + rigors at night.

  • Low grade fever persist after aspiration

  • Next?


Case presentation

  • CT ABD with IV contrast


Case presentation

  • Multiple Prostatic abscesses

  • Largest 4x3 cm

  • Next?


Case presentation

  • 2nd drainage done

  • 25 cc aspirated

  • Continued on meronem

  • Was doing well, no fever for 3 days

  • Went home on Septrin


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