By Tedler D. Depaynos, MD
The 63 years old patient has been experiencing frequent urination and sometimes with severe effort for quite some time. He did not mind it for he was just thinking that it was just part and parcel of ageing because some of his friends and town mates of more or less the same age were experiencing the same.
Gradually he started feeling discomfort in his lower abdomen and he felt that his abdomen seems to be distending. His wife tried convincing him to seek consultation because there were times when he seems to be having fever. He was, however, very adamant because he does not like to experience what one of their neighbors experienced when he went to the hospital. As a hospital routine, a Covid test was done on his admission and he was confined in isolation with no visitors allowed while waiting for the result of his Covid test. It was only after 3-4 days when the result was received and because it was negative, his neighbor was transferred to a room where his relatives could finally be with him. Isolation is a taboo to him.
The discomfort in his lower abdomen gradually worsened and per advise of a relative nurse who happens to be working in a hospital, he underwent a Covid test before going to the hospital for treatment so he will know if he will be isolated or not. Luckily the test was negative so he had no reason not to seek consultation or probable admission.
At the emergency room a vague tender mass was palpated just below the umbilical area and on rectal exam, 4th degree external and internal hemorrhoids were appreciated. A probable “colonic mass” was initially entertained. A simple abdominal x-ray confirmed the mass but the origin was vague. Likewise, did an abdominal ultrasound (UTZ). Since both tests were not definite, an abdominal CT scan was then requested which revealed that the mass was simply a severely distended urinary bladder containing fluid and a little amount of air. When a urinary catheter was inserted, a huge amount of foul smelling orange colored urine was drained and the tender mass disappeared. His relief was manifested by lingering smiles. The attending MDs were also with smiles but at the same time flabbergasted that a simple case confused them.
Upon further review and examination, there was severe urinary tract infection and a slightly enlarged prostate. The patient was also with uncontrolled diabetis mellitus. A young urologist was then consulted who opined that the delay in the treatment of the infection and probably aggravated by the unknown diabetis of the patient with the enlarged prostate caused the severely distended bladder. He feared for a probable ascending kidney infection and especially so that the distant ureters were likewise slightly distended. Massive antibiotics were then given intravenously and medications to reduce the enlarged prostate and to control the diabetis were then given. The urologist then lectured that they have encountered this kind of complications mostly in the elderly and those who have delayed treatment. Because of the severe infection, the danger of sepsis occurring was high.
Meanwhile, conservative management was done for the hemorrhoids and later surgery was advised once he recovered from his severe urinary tract infection. The urologist then recommended that if hemmorhoidectomy would be done, he would also do Trans Uretral Resection of the Prostate (TURP) to reduce the size of the prostate and remove the urinary blockage. The patient promised, however, to think it over.
With the massive antibiotics together with bladder training which was continued on out-patient basis, the patient recovered. The elevated blood sugar was reduced and fortunately the kidney function tests went down near normal values. Strict follow-up was advised and he should not only think it over but should do it or else recurrence would occur!**
