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A few days ago, I happened to go out of the clinic. After seeing two or three patients, an old man dressed neatly and capable and mentally walked in. When I looked up, I immediately recognized the patient. He was Uncle Li who came to see the doctor 4 months ago.
talked to Mr. Li about his recent situation and learned that his urination was much better than before and his quality of life had also improved significantly. When I remembered the scene when I first met him, I sighed very much. When I remembered his exhaustion at that time, compared with now, it was a "three-day" separation, and there was a great change.
1. Initial patient
Mr. Li, 69 years old this year, is in normal health. According to him, he can be regarded as a frequent visitor to the hospital. He was diagnosed with hypertension 20 years ago, and suffered rib fractures and pneumothorax due to trauma in 2016. He also diagnosed with laryngeal cancer in physical examination 11 years ago. At the same time, the physical examination also diagnosed with premature beats. I thought these diseases were enough, but Mr. Li started to have frequent urination , urgency, and difficulty urination 4 years ago. At first, he didn't pay much attention. After communicating with friends around him, he felt that this was because he was older, so he took the prolikang treatment intermittently. However, after taking the medicine, the symptoms cannot be effectively improved, and symptoms such as frequent urination, urgency, and difficulty in urination progressively worsen.
Until 4 months ago, Mr. Li found that he could not urinate independently, and his lower abdomen was also very swollen and painful. After enduring for 10 hours, he went to the emergency room for treatment. The indwelling catheterization failed in the emergency department, so he was referred to the urinary clinic for treatment.
After listening to the patient's self-report, I conducted a specialized physical examination on him. The physical examination showed that the patient had no percussion pain in both kidney areas, no tenderness in the distorted area of both ureters, no tenderness in the supra pubic area, positive tenderness, and percussion voiced .
decided to first be admitted to the hospital with " urinary retention " through his main complaint and specialist physical examination.
2. The treatment process of the patient
After being admitted to the hospital, it is decided to indwell the patient with catheter catheter to relieve the patient's urinary retention and abdominal pain. After the catheter is successfully insulated, imaging and laboratory examinations are further improved. The ultrasound prompts: the bladder is filled with average, the wall is rough, and the sound is poor. There can be seen catheter balloon echo, the prostate size is 5.6x6.5x5.0cm, the contour is clear, and the dot-like strong echo can be seen inside, which is consistent with the manifestation of prostate enlargement and calcification.
combined with imaging, signs, symptoms and other related information to clearly diagnose the patient with prostate hyperplasia and urinary retention. Since the patient has prostate hyperplasia, it is considered to first solve the patient's urinary retention and then undergo surgical treatment to remove the hyperplasia prostate. However, during the communication with the patient, the patient and his family did not agree to the surgical treatment and hoped to treat conservatively first. Considering the patient's wishes and no serious complications such as hydronephrosis, bladder stones, and impaired renal function have been reported, it was decided to change to drug treatment and have regular follow-up examinations. The specific treatment plan is to take telmisartan to lower blood pressure, indwell the catheterization, give antibiotic to fight infection, and take oral tamsolosine hydrochloride sustained release capsules to reduce prostate urethral pressure, improve the patient's urination function and clinical symptoms. After one week of indwelling catheterization, the patient's urine condition was OK. The re-examination ultrasound showed that the residual urine volume was about 8 ml, so the catheter was removed. After 10 days of hospitalization, the patient's urine returned to normal and he could defecate independently.
3. Patients’ precautions during treatment
1. During the indwelling of the urinary catheter, the daily water consumption should be ensured, which can flush the urinary system and reduce urinary tract infections and stones. It is recommended that the daily water consumption should be greater than 2000ml.
2. During the indwelling period, you should pay attention to the unblocking of the urinary catheter, do not cause discounts, force pulling, etc., to avoid adverse consequences such as urinary retention and catheter release.
3. Closely observe the condition, urine condition, abdominal pain, hematuria, and other discomforts.
4. Pay attention to counting the number of urination times and urination volume. Notify the doctor in time when the gap in in and out is too large.
4. Patient treatment effect
After symptomatic treatment such as indwelling catheterization and anti-infection, the patient's urination situation has improved significantly. He can urinate on his own and urinate smoothly, and the residual urine gradually decreases. When discharged from the hospital, the patient had no fever, no nausea or vomiting, and no anterior discomfort. The ultrasound examination showed that the residual urine volume was about 8 ml, so the urinary catheter was removed and he was discharged smoothly. When discharged from the hospital, the patient was asked to continue taking oral tamsolosine hydrochloride sustained-release capsules to improve urination, and then the residual urine and routine urine test were reviewed after 1 month to evaluate the recovery.
5. What should patients pay attention to in daily life
1. Drink water in moderation and do not consume too much water at one time to prevent urinary retention. However, you should not restrict drinking water due to urinary retention. Otherwise, complications such as urinary tract infection and urinary tract stones may aggravate.
2. Learn how to induce urination, such as listening to the sound of running water, stimulating the anus and the inner side of the thigh, tapping the lower abdomen against the perineum, and applying hot compress to the lower abdomen. You can use it when the patient feels unable to urinate, but remember to catheter immediately when it is ineffective and do not hold it in urination for too long.
3. Avoid the causes of urinary retention. For example, those with urinary retention caused by prostate hyperplasia should eat light foods, avoid spicy and irritating foods, quit smoking and alcohol, develop good living habits, do not sit for a long time or overwork, and prevent constipation and holding urine.
4. Return to the hospital for a regular review. If prostate hyperplasia worsens and lower urinary tract symptoms, urinary retention and other conditions appear again, it should be dealt with in a timely manner and treated as soon as possible.
6. Doctors understand that
Prostatic hyperplasia is one of the common causes of urinary retention. Since prostatic hyperplasia is often asymptomatic in the early stages of prostatic hyperplasia, it can only be discovered through regular physical examinations. Therefore, many patients go to the hospital for treatment after prostate hyperplasia reaches a certain level, and suffer from symptoms such as difficulty in urination, frequent urination and urgency, which affects normal life and work. During treatment, many patients, like those present, are often confused about whether surgery is needed and when surgery is performed.
In fact, whether prostate hyperplasia requires surgery mainly depends on the severity of the symptoms of prostate hyperplasia and the patient's wishes. Generally speaking, if the patient's symptoms are not serious, they can be regularly observed or taken oral medication. If the patient's dysfunction worsens, frequent urination, and acute urination symptoms are obvious, residual urination in the bladder increases (more than 60 ml), and urinary retention occurs, surgical treatment should be considered. If further examinations reveal that the patient has hydronephrosis, bladder stones, urinary tract infection or impaired renal function, the operation should be performed as soon as possible.
The patient who visited this time had urinary retention, so after indwelling catheterization, he communicated with the patient about the treatment method. Because the patient was not willing and the current symptoms can also be treated with drug treatment, he decided to take drug treatment after sufficient communication. In addition to active treatment, patients should also change their lifestyle after being discharged from the hospital to avoid worsening prostate hyperplasia. For example, avoid excessive urine retention, do not overwork, do not sit for a long time, and avoid wearing tights. At the same time, they should maintain a good mentality, maintain a good attitude, exercise more, and improve their ability to resist diseases.
Through active treatment, improving lifestyle, and regular reviews, it can improve patients' defecation and improve patients' daily treatment.
Name: Yang Fuli
Unit: Jinzhou Central Hospital
Department: Urology Department
Title: Attending physician
Title: Attending physician
