Urination Problems After Procedure in a Man Treated for BPH

Darshan Rola; Brian Zacharias; Neal Patel; Dhiaeddine Djabri; Alexandra Gabro; Alex T. Villacastin, MD

Disclosures

April 01, 2022

Discussion

Rhabdomyolysis can be excluded in the patient in this case, particularly because of the lack of muscle pain. Patients who are experiencing rhabdomyolysis typically complain of severe proximal muscle pain. Upon physical examination, swelling of the muscles or fever would be noticed. Creatine kinase levels would be up to five times the upper limit of normal. The patient in this case had none of these symptoms or signs, which effectively ruled out this differential diagnosis.

Intraperitoneal perforation of the bladder via insertion of the Foley catheter would have presented earlier; symptoms would start within hours of the perforation. The perforation would also appear on an abdominal CT. An outflow obstruction would not occur, nor would gross hematuria be present. The patient in this case developed urinary symptoms 2 weeks after the Foley catheter was removed, and his CT showed no signs of bladder perforation.

Urothelial cell carcinoma would not present this acutely. Typically, a patient would experience a prodrome of symptoms consisting of fatigue or weight loss. This patient presented acutely with gross hematuria and urinary retention. Although urothelial cell carcinoma can also cause these symptoms, there was no indication of a chronic disease process in the patient's history. A large drop in the hemoglobin level would not be typical of an underlying renal cancer. Finally, the patient in this case did not have low back pain, which can be a symptom of urothelial cell carcinoma.

Benign prostatic hyperplasia (BPH) is a very common condition that usually affects men older than 60 years. It is characterized by the proliferation of smooth muscle and epithelial cells of the periurethral transition zone of the prostate. Although the exact pathophysiology is yet to be discovered, it is thought that lifelong exposure to sex hormones (both androgens and estrogens), neurotransmitters, and other agents leads to continual hyperplasia of the periurethral prostatic tissue and the subsequent development of lower urinary tract symptoms (LUTS), such as urinary hesitancy, frequency, urgency, dysuria, and nocturia. This lifelong exposure highlights the fact that the LUTS associated with BPH become more prevalent with increasing age.[1]

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