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BPH Name:Samuel Esuah Age:72yrs Sex:male Religion:Christian[Anglican] Residence: Agona Sweduro Occu ation: Cocoa !

armer "arrital status:married with # children Re!erred !rom Sweduro $o%&t 'os ital PC-an e isode o! ina(ilty to ass urine)#*+2 ago HPC ,atient was well until #months ago when he could not ass urine in the e%ening associated with a (ulge in the lower a(domen and se%ere ain in the same area- .he ain was sudden in unset/shar in nature/non radiating/had no relie%ing or aggra%ating !actors with no associations'e re orted to Sweduro $o%&t hos ital where a urethral catheter a drain clear urine and there a!ter re!erred to 0ath !or ex ert management-1 months rior to this resentation he had (een ex eriencing straining at micturation/ wea2 stream/intermittency/o! !eeling o! incom lete (ladder em tying- 'e also had !re3uency[45 during the day and#5 at night] urgency and nocturiaODQ 6e%er)%e 7eight loss)%e 8i99iness)%e ,al itations)%e Straining: micturation; 8ysuria)%e 7ea2 stream; <ntermittency; 6eeling o! incom lete (ladder em tying; 6re3uency;[day =5/nite #5] >rgency; Nocturia; 8ysuria) ,enile discharge)%e 'istory o! urethral catherisation)%e ,el%ic trauma)%e 'aematuria)%e PM&SH No re%ious hos ital admission Chronic medical illnesses 8" '.N SC8 .? E ile sy /surgical o )%e 'aemotrans!usion)%e DRUG HX Currently on no long term medications- No 2nown drug allergies-No hx her(al re arations usageFAMILY HX No 2nown !amily hx o! urine retension/ no !amily o! rostatic ca-No 2nown !amily his o! chronic medical illnesses[8" '.N .? SC8 Asthma/E ile sy] SOCIAL HISTORY @i%es at Agona Sweduro with his !amily-'e is cocoa !armer-'e drin2s alcohol ocassionally (ut does not smo2e cigarettesSUMMARY < resent a 72yr old man who resented with an e isode o! ina(ility to ass urine #*+2 ago with as associati%e o(structi%e and irritati%e sym toms-

DIFFERENCIAL DIAGNOSIS @>.O 2ndary to ,rostatic enlargement ?,' ,rostatic ca ?ladder nec2 stenosis >rethral stricture O/E 7ell loo2ing elderly man/who is thin/ not ale/anicteric/a!e(rile well hydratedCVS ,ulse A2( m)regular/good %olume ?, ++B*#B mm o! 'g S+ ; S2 ; B RS RR)+#c m Air entry ade3uate (ilaterally (reath sounds %ersicular with no added (reath soundsAbdome So!t non)tender/no guarding-Rt C @t 2idneys/li%er/s leen not al a(le Shi!ting dullness)%e ?owel sounds resent and normal- 'ernial ori!ices clear No inguinal lym hadeno athy No induration on %entral as ect o! enis DRE ,erianal area healthy Anal tags)%e Anal !issures)%e S hincter tone normal Am ulla is em ty ,rostate is al a(le/ measures 4cm5=cm/ sur!ace is smooth/ median sulcus is al a(le/ symmetrical in sha e non tender/edge is well de!ined/ !irm in consistency/rectal mucosa mo(ile o%er rostateExamining !inger is stained with !aecesMSS .here was no tenderness o%er the s ineCNS ,atient is concious and alert and well oriented in erson lace and time- .one/ ower and re!lexes a ear intactINVESTIGATIONS ,SA .ransrectal >S$ o! rostate ,rostatic (io sy[ transrectal digitally directed core needle (io sy] A(domenal >S$ ?>N/Createnine and Electrolytes >rine R*E >rine C*S Cystourethrogram Ascending urethrogram

Chest x)rayC EC$ 6?C Sic2ling

TREATMENT "edical a+ adrenergic rece tor (loc2ers) ra9ocin/8oxa9ocin/.era9ocin Androgen su resion*4a reductase inhi(itor)!inesteride/Al!asulcin/ .amsulocin Com(ination o! a(o%e ,hytothera y or non medical[minimally in%asi%e and surgical] Surgical methods in%ol%e Open surgery .rans erineal/ Retro u(ic rostatectomy)"illins rostatectomy .rans%ersical rostatectomy)6reyers rostatectomy Laparoscopic surgery .ransurethral Resection o! ,rostate[.>R, sydrome)!luid o%er dose/hy onatraemia/cere(ral oedema/con%ulsions/ ulmonary oedema] .ransurethral incision o! rostate using CO@@<NS 2ni!e INDICATIONS FOR PROSTATECTOMY +-acute re!ractory urinary retention2-chronic urinary retention 1-recurrent e isodes or se%ere haematuria =-(ladder stone 2ndary to ?,' 4-recurrent attac2s o! urinary in!ections in atients with ?,'#- @arge (ladder di%erticula 7-> er tract dilatation due to ?,' D->raemia due to ?,' "inimally in%asi%e surgery High intensity focused ultrasound[HIFU! Transurethral needle ablation[TUNA] Cryotherapy Transurethral electrovaporization of prostate Laser Thermotherapy Intraprostatic stents Balloon dilatation of prostatic urethra. CO",@<CA..<ONS O6 ?,' )acute urinary retention )recurrent >.< )di%erticula )hydrone hrosis )haematuria )calculi ),rogressi%e renal !ailure Com"#$%&'$o ( o) P*o('&'e%'om+ Immed$&'e 'aemorrhage

8amage to (owel/ureter

E&*#+ Clot retention [1 way catheter/(ladder syringe/n*s continuous irrigation] Surgical site in!ection >.< Eersicocutaneous !istula E idydymo)orchitis 8E. L&'e Retrograde eFaculation Osteitis u(is[osteomyelitis o! u(ic (one] >rinary incontinence ?ladder nec2 stenosis >rethral stricture