Cleveland Clinic

A 79-year-old man with severe benign prostatic hypertrophy (BPH) and hypertension was admitted to our hospital with altered mental status. He had no psychiatric history. Two weeks earlier, a CT urogram had shown bilateral hydronephrosis and an enlarged prostate, prompting his urologist to consider transurethral resection of the prostate.

According to his wife, in the days before his admission the patient reported dysuria and cloudy urine and had demonstrated increasingly agitated and paranoid behavior for several weeks. This behavior culminated in a flight from his house after stating that his wife aimed to commit him to the “drunk tank.” He was soon found and brought to the ED in an agitated state. Despite normal vital signs, serological studies showed acute kidney injury, with creatinine levels five times above baseline without uremia. Urinalysis suggested urinary tract infection (UTI), which was later confirmed by culture.

Learn about the case that underscores the dynamic potential interactions between brain and bladder.

Resolution

why you should join Figure 1

• Share your knowledge with our global community of healthcare professionals
• Get help from experts in your field
• Learn from our library of real-world cases and quizzes

A 55 years old male came to clinic with obstructive symptoms, his IPSS severe and required an Foley's Intermittent catheter. He is known diabetic and hypertensive. On examination it appear symmetric non nodular movable long swelling of prostate. Transrectal US reveal an 180 g prostate. He is a candidate of open prostatectomy but we try to do exploratory cystoscopy and it TRUP is possible but requires multiple sessions. So move to open prostatectomy is better to the patient.

Pt presented to ED for a "bowel obstruction." It turns out he used a 7" length of PVC pipe to "massage his prostate." He was admitted to OR for removal.