Patient S, male, 68 years old, came to the AA hospital 3rd November 2012

Unable to void since 1 day before admission to the hospital

Unable to void 1 day before admission to Arifin Achmad Hospital 1 day ago the patient complained unable to void and then went to Arifin Achmad Hospital and an 18 folley catheter was inserted easily and 500 ml of yellow clear urin came out.

He suffered Lower Urinary Tract Symptoms (LUTS) chiefly Incomplete emptying, nocturia, frequency, intermitency, weak stream, overflow incontinesia International Prostate Symptomps Syindrom (IPSS) 24 (severe) with Quality of Life 5

Incomplete emptying Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating? Frequency Over the past month, how often have you had to urinate again less than two hours after you finished urinating? Intermittency Over the past month, how often have you found you stopped and started again several times when you urinated? Urgency Over the last month, how difficult have you found it to postpone urination? Weak stream Over the past month, how often have you had a weak urinary stream? Straining Over the past month, how often have you had to push or strain to begin urination?

Less than 1 time in Less 5 than half the About time half the time More than the half Almost time always 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Not at all

Nocturia
Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?

0 1 2 3 4 5

Quality of life due to urinary symptoms If u were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

Delighte d 0

Please d 1

Mostly satisfied 2

Mixed

Mostly dissatisfie d 4

Unhapp y 5

5 times or more
Terrible 6

2 times

3 times

4 times

1 time

None

Total score : 24 (severe) Quality of life : 5

There is no hematuria, there is no flank pain, no stone comes out from urination Since 3 month before came to the AA Hospital the LUTS chiefly intermitency, weak stream, overflow incontinesia, nocturia, frequency. There is no hematuria, there is no flank pain, no stone comes out from urination

There is no DM There is no Hypertension

Generalized condition : mild illness Conciousness : composmentis

Vital sign BP : 120/80mmHg RR : 240x/minutes P : 72 x/minutes T : 36,5 C

Head and Neck : within normal limit Chest : within normal limit Abdomen : within normal limit Urogenital tract : Localized Status Extremity : within normal limit

Costovertebrae Angle
CVA Inflammatory sign Scar Tenderness Knock pain Ballotement Dextra Sinistra -

Local Status
Suprapubic Area Inspection : Flat Palpation : Bladder is not palpable

Externa Genitalia Penis Urerthra: Inserted 18 F catheter clear yellow urin with good flow Scrotum Within normal limit

Digital Rectal Examination Anal Sphincter tone is normal. Bulbocavernosus Reflex (+) Smooth mucose Prostate : enlarged, consistency firm , symetric, smooth surface, no tenderness and no hard nodul. Handschoon: feses (-), no blood, no mucus

Urinary Retention due to Prostate Enlargement Suspectious Benign (BPH)

Differensial Diagnosis Urinary Retention due to Prostate Enlargement Suspectious Malignantcy (Ca Prostate)

Urinalisis Rutine Blood Renal Function PSA Trans Rectal Ultrasonography (TRUS) BNO - Cystography

Urinalisis : Rutine Blood : Eritrocyte content : 10.8 gr% White blood cell : 13.700/ mm3 Haematocryte : 37,3 % Trombocyte : 485.000 / mm3 Renal Function Ureum : 17,1 mg/dl Creatinin : 0,78 mg/dl PSA :TRUS USG ren, ureter, vesica urinaria, prostat BNO - Cystography : -

BPH with Urinary Retention

TUR Prostate