History

PAIN
Patient Bilal S/O Ali, 40 yrs old, married R/O Lahore, farmer by
occupation Admitted through OPD 5 days back with complaint of right
flank pain from last 2 years.
Patient was in usual state of health 2 years back when he developed
right flank pain, which was sudden in onset, severe unbearable in
intensity, dull in character, neither shifting nor radiating, no aggravating
factor but relieved mostly with oral medication, he remained pain free
for one week then mostly similar pain reoccured. He mostly visited local
hospital where he was prescribed some oral medication.
No such pain on contralateral side.
He also gave history of stone passage 2yrs ago which was black in Color
with irregular margins, which was not submitted for analysis.
It was not associated with fever, vomiting, trauma,uremic symptoms ,
Mass or weight loss. He voids with single good caliber stream without
any H/O Lower urinary tract symptoms.
His systemic enquiry is unremarkable.
LUTS
Patient Bilal S/O Ali, 70 years old, married, farmer by occupation,
resident of Lahore admitted through OPD 5 days back with complaint of
lower urinary tract symptoms from last 2 years.
Patient was in usual state of health 2 years back when he gradually
developed lower urinary tract symptoms which were mostly mixed/
storage / voiding in nature including increased frequency, urgency,
nocturea, hesitancy, weak stream, intermittency, straining and
incomplete emptying. Although IPSS is filled by patient and it is estimate
 of last one month But my rough estimate of IPSS score lies in moderate
category. He is unsatisfied due to his symptoms.
Patient denies any history of retention of urine, hematuria, pyurea,
dysuria, or incontinence.
It was not associated with fever, vomiting, stone passage, trauma,
uremic symptoms, flank pain , Mass or weight loss.
For this complaint he visited local Hospital where he was prescribed
some medication which is taking occasionally/regularly.
His systemic enquiry is unremarkable.

AUR (Acute)
Pt Bilal S/O Ali 70 years old, married, farmer by occupation, R/O Lahore,
admitted through emergency 5 days back with complaint of retention of
urine.
Patient was in usual state of health 5 days back when he developed
sudden retention of urine, associated with suprapubic pain, for which he
visited Emergency where perurethral catheterization was performed by
Doctor which was uneventful and 500 ml clear urine was drained. His
retention was not associated with postponement of urine, any
medication or constipation. He was prescribed some medication after
catheterization and trial without catheter is still not given.
It was not associated with hematuria, pyurea, dysuria, or incontinence.
Also no H/O fever, vomiting, stone passage, trauma,uremic symptoms ,
flank pain , Mass or weight loss.
His systemic enquiry is unremarkable.
ROU (Chronic/BPH)
Pt Bilal S/O Ali 70 years old, married, farmer by occupation, R/O Lahore,
admitted through OPD 5 days back with complaint of retention of urine 5
months ago.

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 Patient was in usual state of health 5 months back when he developed
sudden painless retention of urine, associated with uremic symptoms
including Nausea and vomiting, for which he visited Local Hospital where
perurethral catheterization was performed by Doctor which was
uneventful and 1000 ml clear urine was drained. His retention was not
associated with postponement of urine, any medication or constipation.
He remained admitted for 2 days for IV hydration and medication. Later
on he was discharged on some medication and trial without catheter
was given after 4 days but failed, so he was again catheterized. Since
then he remained on catheter drainage.
It was not associated with hematuria, pyurea, dysuria, or incontinence.
Also no H/O fever, stone passage, trauma, flank pain or Mass and weight
loss.
His systemic enquiry is unremarkable.

Hematuria (Bladder Growth)

Pt Bilal S/O Ali 70 years old, married, farmer by occupation, R/O
Lahore, admitted through emergency 5 days back with complaint of
hematuria from last 6 months.
Patient was in usual state of health 6 months ago when he noticed
painless hematuria mixed with urine along with round shape clots. It
occasionally relieved by medication for few days then reoccured. It was
not associated with exercise, instrumentation, trauma or blood thinners
intake. It progressed over time and it was associated uremic symptoms
including nausea and vomiting, significant weight loss and foreign travel
to Saudi Arabia. He smoked 1 pack daily for last 20 years. He also gave
history of 2 pints blood transfusions.
He he denies any history of pyurea, dysuria, incontinence, fever,
vomiting, stone passage, flank pain or mass. However it was associated
with LUTS and retention of urine.

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 Hematuria (Renal Mass/Stone)
Pt Bilal S/O Ali 70 years old, married, farmer by occupation, R/O
Lahore, admitted through OPD 5 days back with complaint of hematuria
from last 6 months
Flank pain/mass 6 months
Patient was in usual state of health 6 months ago when he noticed left
flank pain radiating to growin…. (Same as Pain Hx) which was also
associated with hematuria mixed with urine along with thread shape
clots. It occasionally relieved by medication for few days then
reoccured. It was not associated with exercise, instrumentation, trauma
or blood thinners intake. It progressed over time and also associated
with uremic symptoms including nausea and vomiting, significant weight
loss. He smoked 1 pack daily for last 20 years.
He he denies any history of significant StoraIt that'll be cheese other
Christmas and voiding LUTS, pyurea, dysuria, incontinence, retention of
urine. He also denies H/O fever and stone passage.
Mass
Patient Bilal S/O Ali, 40 yrs old, married R/O Lahore, farmer by
occupation Admitted through OPD 5 days back with complaint of right
flank mass from last 2 months.
Right Flank Mass 2 months
Patient was in usual state of health 2 months back when he noticed
right flank mass associated with mild pain, however there were no
noticeable aggravating or relieving factors.
It progressed with time and also associated with significant weight loss.
He smoked 1 pack Daily for last 20 years.
It was not associated with fever, vomiting, stone passage, trauma and
uremic symptoms. He voids 5 times a day, rest of the voiding history is
unremarkable.

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 For this complaint he visited local Hospital where he was prescribed
some medication which is taking occasionally/regularly.
His systemic enquiry is unremarkable.
Systemic Enquiry
There is no history of fits , loss of consciousness, cough, dyspnea,
pedal swelling, palpitation. There is also no history of abdominal pain,
joints pain, bone pain or backache.
Past Hx
He denies any history of diabetes, hypertension , asthma, TB,hepatitis,
ischemic heart disease or any surgical intervention in past. Also there is
no history of any blood transfusion, medication intake and drug allergy.
Personal Hx & Diet Hx
ABCDE (Appetite, Bowel, Cigarette, Diet, ED)
His sleep appetite and bowel habits are not altered. He is non smoker
he drinks he drinks 8 to 10 glass of water per day and does not uses
added salt in his meal. He eats meat three times per week. He denies
any history of erectile dysfunction and his family is complete(in case of
BPE for future treatment).
Family Hx
His family history is not suggestive of diabetes, hypertension, IHD, TB ,
tumor or stone disease.
S/E
He belongs to middle class and lives in his own house.

Examination
GPE
A middle aged man of Average height and built lying comfortably over
bed with well oriented to time place and person & having vitals of

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 Pulse 80 beats per min
Temp of 98 F
R. R of 16 breaths per min
BP = 130/80
Rest of general physical examination is unremarkable.
Abdomen
Regarding his abdominal examination
On inspection abd is flat/protuberant with centraly located inverted
umbilicus and has prominent veins or any scar marks
Both hernial orifices are intact with neg cough impulse.
On superficial and deep palpation abdomen is soft and non tender with
no appreciable visceromegaly and upper border of liver is percussable in
5th intercostal space.
Bladder is not percussable
& shifting dullness is neg.
On auscultation Bowel sounds are audible but no renal bruit was heard.
Regarding genitalia examination
Meatus is normally placed at tip with normally palpable urethra and
corpora.
Both Testes are normal with neg cough impulse and no evidence of
varicocele.
On DRE
There is normal perianal sensation, no anal skin tags or fissure. Anal tone
is normal.
Prostate is moderately enlarged, firm in consistency with smooth
overlying mucosa, median sulcus is palpable & no palpable nodule
Bulbocavernous reflex is present

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 On withdrawal finger was fecal stained
Regarding chest examontaion
Trachea is centrally palced
Chest expansion is equal on either sides with normal vocal resonance
Percussion notes are resonant on either sides of chest
On auscultation normal vesicular breathing is heard with normal vocal
fremitus
Similar examination findings were present over back.
NEUROLOGICAL EXAMINATION
On neurological examination patient is fully conscious, well oriented in
time, place and person and all examined cranial nerves were intact.. In
both upper & lower limbs sensations are intact, bilaterally and power is
also normal. Both plantars are down going and all other reflexes along
with gait were normal.