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Case presentation

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

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  1. Case presentation Academic day 13/02/2014 MUBARAK ALKABEER HOSPITAL

  2. Case #1 • A 55 years old Kuwaiti lady • Admitted through urology OPD • C/O frequency. • Next?

  3. 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?

  4. 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?

  5. Examination Afebrile Vitally stable Unremarkable examination Next?

  6. 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?

  7. KUB

  8. CT KUB

  9. 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?

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

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

  12. Case #2 • A 76 years old gentleman • Complaining of severe dysuria and frequency. • Next?

  13. 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?

  14. No past medical or surgical history • Not on any medication • No history of stone disease • Non smoker • Next?

  15. Examination • T 39.2 • BP 150/85 • HR 91 • Abdomen was soft, not tender. • DRE : • moderate enlarged prostate, tender. • No nodules. • Next?

  16. Labs • CBC : WBC 13.6 Hb 134 • RFT : Within normal range • Urine R/M (dipstick) ++WBC, +RBC Next?

  17. Started on Amikacin 1g IV OD and Rocephin 1g IV OD • Ultrasound • Urine & Blood culture • Next?

  18. U/S Pelvis • 70 cc prostate • Pre void 260 ml • Post void 60 • Next?

  19. 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?

  20. Antibiotic shifted to Meropnem 1g IV/8h • Vital signs monitoring • Repeat CBC, RFT and trace cultures • Next?

  21. Urine C/S : No growth • Blood culture : No growth • Next:?

  22. TRUS

  23. 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

  24. The other day, patient spiked fever of 39C + rigors at night. • Low grade fever persist after aspiration • Next?

  25. CT ABD with IV contrast

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