diagnosed to have diabetes mellitus, ischaemic heart disease, bronchial asthma, hypertension, drug, food or plaster allergy.
Examination
He is of average build.
Not pale (CRF, bone marrow secondaries)
No scalp lumps (bone metastasis)
Left supraclavicular lymph node enlargement
(Virchow’s node, Troisier’ s sign)
Ankle oedema (in CRF)
Abdominal Examination
Inspection
Suprapubic fullness (due to a distended bladder).
Is there a scar due to prostatectomy or due to inguinal herniotomy?
It is mandatory to examine the external genitalia.
Phimosis.
If there is no phimosis – Check for external meatal stenosis.
An indurated area along the ventral surface of the shaft of the penis is indicative of a urethral stricture.
If the patient is on a catheter it is rational to exclude tight phimosis, external meatal stenosis and urethral strictures.
Check whether the testicles are swellen and tender (epididymoorchitis), whether
epididymis.
Straining results in bilateral inguinal herniae. If the patient is having herniae and out flow tract obstruction, first relieve the obstruction i.e. prostatectomy, then the herniotomy.
If the patient is catheterized suprapubic tenderness indicates cystitis.
Look for any loin tenderness or ballotable loin lumps.
In an old man with haematuria and a loin lump exclude renal cell carcinoma.
Examine the cardiovascular system for any hypertension,cardiomegaly with a heaving apex (CRF due to obstructiveuropathy)
Digital rectal examination (DRE)
The anal sphincter tone is lost in cauda equina syndrome. i.e. a
patulous anus.
Benign prostate is firm in consistency, the surface is smooth. the median groove is palpable, the rectal mucosa is freely mobile, the gland is enlarged.
Malignant prostate is hard in consistency, the surface is irregular or nodular, the median groove is obliterated, and the rectal mucosa is fixed, and sometimes ulcerated.
NB:
The median lobe of the prostate enlarges into the bladder; hence it is not possible to detect it by DRE.
Summary:
A 76 year old man with acute retention of urine with some obstructive and irritative symptoms of bladder out flow tract
obstruction without any other complications or co-morbidity,
probably due to benign prostatic enlargement (BPE).
Investigations
The aims:
Confirm with urodynamics.
Assess the renal function.
Imaging.
Exclude malignancy.
Assess the fitness for surgery.
continue read… Part 4
