Concluded Case

Prostatomegaly differential diagnosis

A 71 years old male patient complaining, pain abdo, difficulty in urination, urgency to urinate, frequently at night, dysuria, fever,constipation, xerostomia, sometimes patient feels severe abdominal pain at UR and also supra pubic region, orthopnoea too. Edematous at lower limbs. O/E BP 160/100mmHg HB 68bpm Chest B/L clear AS/ tenderness CVS s1 & s2 clear DM° What will be the proper investigations and the management......? Cystourethroscopy prostetic biopsy CBC RFT & other important haematological investigations also have been advised ECG reports show LBBB suggest me soon respected doctors

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The features Suggestive of Renal failure due to back pressure by gr 3 enlarged prostate with long standing hypertension. Protate is hugely enlarged by weight and residual urine is also high. Pt is having chronic retention causing back pressure changed and Renal failure First catheterise the patient and measure the urine output, continuous drainage may release the back pressure change. Gor for Renal function test if urea label high , do it after 15 days after continuous drainage Treat hypertension with diuretics, this will help in reduction of swelling of legs May go for Cystoscopy no biopsy now, go for PSA if label high more then 10 then biopsy may considered., before that CT is the must to see the capsule is intact or not Along Tha start Tab Tansulosine 0°4 mg daily at night.

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BPH Gr III with Umbilical hernia. Advice : 1. Non selective Alpha-1 Blockers(Prazosin, Alfuzosin Terazosin etc) . It will take care of both hypertension and BPH. Start at bed time as initial doses may cause postural hypotension. If BP not controlled may combined with antihypertensive of your choice. Remember Alpha-1A (Tamsulosin and Silodosin) doesn't have any role on BP control and Alpha-1B reduces BP but doesn't have role on BHP treatment. 2. Advice PSA. If value more than 10 then highly suspicious for CA. In that case must advice Prostate Biopsy for HPE. For value less than 5 usually need no biopsy. For 5-10 better to have the biopsy. 3. Rule out Kidney failure advise atleast Creatinine. R/O associated UTI advice R/E & M/E of Urine. 4. Give stool softner and avoid raised intra abdominal pressure to take care of Umbilical hernia. Better to have a surgeon's opinion.

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The features Suggestive of Renal failure due to back pressure by gr 3 enlarged prostate with long standing hypertension. Protate is hugely enlarged by weight and residual urine is also high. Pt is having chronic retention causing back pressure changed and Renal failure First catheterise the patient and measure the urine output, continuous drainage may release the back pressure change. Gor for Renal function test if urea label high , do it after 15 days after continuous drainage Treat hypertension with diuretics, this will help in reduction of swelling of legs May go for Cystoscopy no biopsy now, go for PSA if label high more then 10 then biopsy may considered., before that CT is the must to see the capsule is intact or not Along Tha start Tab Tansulosine 0°4 mg daily at night.

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Respected "Dr.Maqusud Sir it's a Critical case. According to Complications More difficulties to treat the patient. I think "Prostate specific Antigen"/PSA 10/PSA 20 do urgently for Confirmation. Your management always b best I think Cap Urimax 0.4 also add. M also Agree to "Dr.Dinesh Gupta Sir".

Tnx "Dr.Shaheen Ma''am"
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Cap.Nupenta Cap. Geriflo Cap. Ramcor 5mg Tab. Levomac 500mg Tab. Flavomark 200mg These medicines are advised by me instantly....

I agreed with You
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SUGGESTIVE. I. OF CHRONIC RENAL. FAILURE... WITH H T N.... ADVISABLE R / O.... SEPTICEMIA

Thanks respected Dr. Dinesh sir
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Prostate biopsy

Thanks respected Dr. Pushker sir
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Prostomegaly, Do PSA 10 & PSA 20, and must also prostatic biopsy

Thanks dear Rajendra Rai sir
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Yes he is a c/o prostomegaly Go for PSA and prostatic biopsy

Thanx dr Shaheen Parveen
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Per rectal examination to know consistency of prostate Investigation- Cbc,RFT, urine routine and culture, PSA,bsl fasting, pp. Start alpha blocker (tamsulosine/alfuzosine) Antibiotics if culture positive- If PSA high with positive urine culture it may be secondary to urinary infection - then need to repeat PSA after antibiotics Also large gland 110 gm can have relatively high psa >4 Pain can be due to umbilical hernia Needs diabetes care if sugars high and antihypertensives

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It's a case of protomegaly.PSA and prostatic biopsy will be required.

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