80/M with Hematuria, nocturia, dysuria, urge incontinence and uncontrolled sugars.

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80 year old male has come to urology opd with c/o :

Nocturia since 2 months

Poor urinary stream since 2 months

Urge incontinence since 2 months 

Hematuria since 3 days

Dysuria since 1 day 

Patient was apparently alright 2 years ago, then he developed acute urinary retention. He was catheterised and is on foley’s since then. 

Since 2 months, he developed nocturia.  

Poor stream + 

Dribbling + 

Urgency + 

Urge incontinence +

Hematuria since 3 days + Not associated with passage of clots 

Dysuria since 1 day + 

No h/o turbiduria

No h/o fever , vomiting , nausea 

No h/o loss of weight , loss of appetite 

H/o voiding trial given 5 months back and failed. He was advised surgery but the patient refused.

He was referred to general medicine i/v/o uncontrolled sugars secondary to non compliance to medication with carcinoma bladder , benign prostatic hyperplasia and urinary tract infection.

Past history :

K/c/o DM since 3 years and is on medication (Tab Metformin 500 mg + Glimiperide 2 mg PO/OD) 

K/C/O HTN since 1 year and is on medication (Tab Telma 20 mg PO/OD) 

N/k/C/o epilepsy, asthma, CAD, thyroid disorders.

Personal history :

Sleep : adequate 

Diet : mixed 

Appetite : normal 

Bowel and bladder : regular 

Addictions :  smoking - sutta since the age of 16. (7-8 per day)

Consumes alcohol (90ml) occasionally 

General examination:

Pt is conscious, coherent and cooperative 

No pallor , icterus , cyanosis, clubbing, lympadenopathy, edema

Vitals : 

PR: 78 bpm

RR: 14 cpm

BP: 120/70 mmHg

GRBS :  256 mg/dl 

Systemic examination : 

CVS :  S1 S2 heard no murmurs

RS : BAE NVBS heard.

P/A : soft non tender 

No free fluid.

CNS : No FND

Local Examination : 

External genitalia normal 

B/L direct hernia +

P/R - Grade 2 Prostatomegaly +

16 Fr foley’s in situ

Hematuria in urobag 

Investigations : 

 

ECG :

Ultrasonography :

Treatment : 

TAB OFLOX 200 mg PO/BD

TAB PAN 40 mg PO/OD

SYP ALKASTON 15 ml in 1/2 glass of water PO/BD

TAB TAMSULOSIN-D PO/HS

INJ HAI 8 IU SC TID

INJ NPH 6 IU SC TID 

TAB GLIMICUT M2 PO/OD

SYP POTKLOR 15 ml PO/TID