Obstructive Urinary Symptoms

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of obstructive urinary symptoms

Onset was ‍gradualsudden

Symptoms include:

‍hesitancy

‍weak stream

‍intermittency

‍straining

‍incomplete emptying

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍pelvic pain

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Impact on ‍daily activitiessleepworksocial lifemental health is ‍nonemildmoderatesevere



No history of: ‍benign prostatic hyperplasia, ‍prostate cancer, ‍pelvic surgery, ‍urinary tract infection, ‍neurogenic bladder, ‍bladder stones, ‍urethral stricture

No use of: ‍diuretics, ‍antihistamines, ‍antidepressants, ‍muscle relaxants, ‍opioids, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Obstructive urinary symptoms ‍likelysuspectedpossible

DDx: benign prostatic hyperplasia, urethral stricture, bladder neck obstruction, prostate cancer, urethral calculus, bladder stones, urinary tract infection, neurogenic bladder, phimosis, paraphimosis, pelvic mass, constipation, medication side effect, pelvic floor dysfunction, foreign body in the urethra, meatal stenosis, posterior urethral valves, functional bladder outlet obstruction, pelvic organ prolapse, cystocele, spinal cord injury, neurologic disorder, genital HSV infection





PLAN:

Investigations:

- Urinalysis

- Urine culture

- Blood work: ‍CBC, ‍creatinine, ‍CRP

- Renal ultrasound

- CT scan of the abdomen and pelvis

- Uroflowmetry

- Post-void residual urine volume

Treatments:

- Avoidance of caffeine, alcohol, and large fluid intake

- Voiding diary

- ‍Alpha-blockers

- ‍5-alpha reductase inhibitors

- ‍Anticholinergics

- ‍Mirabegron

- Transurethral resection of the prostate

Further care:

- Referral to urologist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as fever, hematuria, or urinary retention