#MedicalCase

C/C Retention of Urine (General Surgery)

Sanya Dhingra., MBBS

 

Medical Case Details:

55-year-old male patient with c/o retention of urine and lower abdominal pain. On USG, enlarged prostate and median lobe of prostate pressing on the bladder seen. The patient was started on Flotral tablet (1 tablet daily). The patient develops constipation on and off. On Digital rectal examination, there is an anal fissure. The patient was treated for constipation with laxatives and sitz bath. The patient still continues to have the fissure and pain at the site after defecation, despite a history of soft stools and regular bowel movement. Any suggestions on how to convince the patient. Is Flotral causing these symptoms? Should the patient be advised a laser surgery for fissure?

 


    Discussions


    Dr. Venkatesh
    General Practitioner

    1. do CBC to r/o Anemia
    2. what is the urine quantity of post void
    3. Treat Fissure by surgical intervention
    4. based on urinary symptoms, advise prostatectomy

    ▲ 1
    22.Nov, 12:25am

    Dr. Sanya Dhingra
    General Practitioner

    Thankyou Dr. Venkatesh.
    Patient’s Hb is 15.9gm% . Post void urine quantity is normal . Patient refuses any surgical intervention.

    22.Nov, 12:29am

    Dr. Sanya Dhingra
    General Practitioner

    Thankyou Dr. Venkatesh.
    Patient’s Hb is 15.9gm% . Post void urine quantity is normal . Patient refuses any surgical intervention.

    22.Nov, 12:29am

    Dr. Venkatesh
    General Practitioner

    1. age is 55 years, r/o Diabetes and HTN, so monitor for symptoms of BPH later part.
    2. explain to him about possible complications of anal fissure, like blood loss, pain, developing of fistulas, IBS
    3. Talk to his wife or children

    ▲ 1
    22.Nov, 12:43am

    Dr. Uthrapathi Sakthivel
    Siddha Medicine Specialist

    The pt has old age and retention of urine these are get the reason for constipation doctor kindly advise him to have adequate amount of water & sit bath after defecation.
    Sit bath will help him to get better feel from irritation or burning sensation of anal region and adequate amount of water intake will help pleasent defecation with laxative.
    And also advise him take lot of fruit like gova,black grapes,red banana even if he not have DM.

    ▲ 1
    04.Dec, 08:23pm

    Dr. Ashish Ganatra
    General Surgeon

    You need to give Metronidazole or Satronidazole, add an analgesic in proper dose, round the clock & PPI+ITOPRIDE before dinner for 5 days

    ▲ 1
    06.Dec, 01:41pm

    Dr. Sanya Dhingra
    General Practitioner

    Hello and Thankyou to everyone for their valuable advise .
    Patient has been doing sitz bath for more than a month now and is following strict dietary advise given for constipation . With laxatives , there is no constipation but once the medication is stopped , problem re occurs . Also ciploxTZ has been prescribed earlier.


    06.Dec, 09:38pm

    Dr. Sanya Dhingra
    General Practitioner

    Hello and Thankyou to everyone for their valuable advise .
    Patient has been doing sitz bath for more than a month now and is following strict dietary advise given for constipation . With laxatives , there is no constipation but once the medication is stopped , problem re occurs . Also ciploxTZ has been prescribed earlier.


    06.Dec, 09:38pm

    Dr. Sanya Dhingra
    General Practitioner

    Hello and Thankyou to everyone for their valuable advise .
    Patient has been doing sitz bath for more than a month now and is following strict dietary advise given for constipation . With laxatives , there is no constipation but once the medication is stopped , problem re occurs . Also ciploxTZ has been prescribed earlier.


    06.Dec, 09:38pm

    Dr. P. Sukumaran
    General Surgeon

    Dear Dr. Sanya Dhingra,

    The possibility of acute Urinary Retention in this case may be because of one of two reasons:
    1. Acute Fissure in ano causes pain leading to retention
    2. Prostatomegaly causing urinary retention
    Once Fissure pain in alleviated with laxatives and topical agents usually these patients void well.
    If the problem persists a trial of alpha blockers should be given for 14 days before attempting a catheter removal.
    1. Flotral which is Alfuzosin 10 mg is not known to produce constipation.
    2. Is the patient still on Catheter?
    3. If the renal parameters are normal Silodosin 8mg once daily is a better medication at this stage.
    4. You have not mentioned about size of prostate. Please do make a note.Similarly get a PSA done
    5. What if Laser Surgery for fissure is done and then the patient doesn’t void after Catheter removal? So need not do it as of now.
    Kindly give a trial void after 2 weeks of Silodosin therapy

    07.Dec, 03:26pm



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