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Benign prostae hyperplasia

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Patient is diagnosed as BPH 1.5 years ago. Now this patient is on tamsulosin 0.4mg for about 1.5 years and he has no complaints of urinary incontinence or any other problem. Tamsulosin should be given for lifelong or it can be stopped now. Any expert ideas please???

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Case Summaries

58-year-old male:

1. Grade 2 prostate enlargement (with little to no urinary symptoms)
2. BMI of 28
   With no other clinical symptoms nor presentations, came with this report (self-referred) in view of his enlarged prostate.
   Is this anything alarming since oncology is not my forte? What should I recommend for this patient if at all anything?

75-year-old male:
Presented with LUTS for 7 years on medical therapy using an alpha blocker and 5-alpha reductase inhibitor.
Which organ is this?! What are the indications for surgery?!

A 62-year-old patient:
With difficulty in passing urine, decreased urine output, no burning sensation, pain in abdomen, normal bowel habit.
Systemic examination: per rectal examination shows normal anal tone, hard mass in anterior part.
Examination shows enlarged prostate approximately 49.4 gm in weight.
Grade I prostatomegaly.
Treatment: Tab tamsulosin 0.4mg po od 2 weeks.
Prostatic specific antigen (PSA): 4.62ng/ml.
What should be done for further management of the patient? Is surgery necessary?

A 79-year-old man:
With severe benign prostatic hypertrophy (BPH) and hypertension, 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, he 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.

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Presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and he was promptly referred to the emergency department.

A 28-year-old woman:
Presented with a 3-day history of intense pruritus over the lower back.
She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant:
Presented with skin lesions localized to the chin for the past 3 days.
Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens:
Presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this EKG that would warrant further work-up, or is this just a pediatric EKG?