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CHAPTER III

CASE ANALYSIS

Mr. RS, 74 years old man, admitted to Mohammad Hoesin General

Hospital Palembang with chief complaint Unable to void one week before

admitted to hospital.

1 years before admissions patient complaint of difficulty to void, had to

push to begin urination, decreased force and caliber of stream, stopped and started

again when urinated, post void dribbling. Voiding at night up to 5 times at night(nocturia), difficult to postpone urination, and had sensation of incomplete bladder

emptying. Bloody urination (-), stone in urin (-), defecate (+) normal, fever (-),

and loss of body weight (-)

6 month before admission, patient complaints pain when urinating,

uncomfortable when urinating, stopped and started again when urination with

changed the position of the body. Patient also complaints pain in the lower

abdomen that referred to the tip of the penis and the scrotum. There is no bloody

urination, stone in urine (-).

1 month before admission patient complaints pain when urinating and

become more severe after urination, there is bloody urination, stone in urination

(+). The patient has no fever and there is no decrease of body weight.

One weeks before admission patient complaint unable to void and bulging

in suprapubic. He was admitted to Charitas Hospital and urethra catheter was

fixed. Then he was reffered to Mohhamad Hoesin General Hospital Palembang to

get more therapy.

From physical examination, general examination was normal. On local

examination, there is tenderness on suprapubic regio. External genitalia

examination, from inspection the urethra catheter No.16 F was fixed, urine clear

and no bloody urine. On rectal toucher examination TSA good, enlargement of the

prostate, upper boarder of prostate unpalpable, rubbery consistency, flat surface,

no tenderness, feaces (+), blood (-).

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From laboratory examination, there is slightly decreasing of hemoglobin

and increasing of LED. From BNO examination, there is radioopaque appearance

in vesicae urinaria. From USG examination, there are prostate enlargement (50 x

54mm) and multiple stones in vesica urinary.

From anamnesis, physical examination, laboratory,BNO and USG finding

this patients diagnosed is suspect BPH and vesicolithiasis. The treatment for this

patient is Transurethral Resection of the Prostate (TURP) for the BPH and

vesicolithotomy. After TURP, prostate tissue is sent to a pathologist to see if the

patient is actually suffering from benign prostate hyperplasia or prostate cancer.

Prognosis for this patient, quo ad vitam is bonam dan quo ad functionam is dubia

ad bonam.

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REFERENCE

1. Thompson JC. 2002. Netter's Concise Atlas of Orthopaedic Anatomy.Saunders elsevier, Philadelphia.

2. Keith L M, Dalley FD.2006. Clinically Oriented Anatomy, 5th ed. LippincottWilliams & Wilkins. USA.

3. Chapter 1-Anatomy of the Genitourinary Tract : Wein AJ, kavoussi LR, PartinN, peters CA. 2007. Campbell-Walsh Urology: 9th ed, volume 1. Saunders

Elsevier. Philadelpia.

4. Chapter 84 - Lower Urinary Tract Calculi: Wein AJ, kavoussi LR, Partin N,peters CA. 2007. Campbell-Walsh Urology: 9th ed, volume 1. Saunders

Elsevier. Philadelpia.

5. Chapter 36 - Disorders of the Bladder, Prostate, & Seminal Vesicles :WeinAJ, kavoussi LR, Partin N, peters CA. 2007. Campbell-Walsh Urology: 9th

ed, volume 1. Saunders Elsevier. Philadelpia.

6. Tanagho EA, McAninch JW. 2008. Smith's general urology; 17 th ed. McGraw Hill, Lange.New York