A 60 yr old man comes with c/o pain abdo n poor stream of urine., Serum inv Na-140, K-4.9 Creat 5.3,urea 120. USG shows 70gm prostate b/lhydronephrosis with hydroureter, residual urine post voiding:400 ml. Immediate management include
|A||Do a, CT to check for prostate ca|
|B||Pass a Foley’s catheter to drain bladder|
Campbell says Ale urinary retention related to BPH is often caused by dynamic factors because a significant portion of men void spontaneously after catheter placement.
Protocol followed in NC urinary retention related to BPH is as follows:
a. Catheterize the patient and start α-blockers
b. If patient could not be catheterised due to extreme degree of obstruction, suprapubic catheterisation is to be done
c. If the patient was catheterised successfully, give a voiding trial after 3 days, keeping the patient on a-blockers.
d. Derangement in serum creatinine will settle down with bladder level drainage, if there is no irreversible loss of renal function. There is no indication for percutaneous nephrostomy as obstruction lies below bladder and when bladder level drainage serve the purpose better. Percutaneous nephrostomy is done in upper urinary tract obstruction.
e. CECT is never indicated in BPH evaluation, moreover contrast enhanced CT is not done in patients with deranged serum creatinine because contrast is nephrotoxic.
Deranged renal function is an indication for TURP but it is never an immediate management. It can be done after optimizing patient with preurethral catheterization.