Academic day 13/02/2014MUBARAK ALKABEER HOSPITAL

A 55 years old Kuwaiti lady Admitted through urology OPDC/O frequency.

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Case #1

Present hx Started 6 months backSevere dysuria, frequency and hematuria.Passed small fragment with the urine 4 months

back.Not associated with loin pain, fever or nauseaNot known as a stone former

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Medical historyPMH : NillPSH : tension-free vaginal tape one year ago

by gynecologist. Was complaining from stress incontinence.

Not on any medication.3 daughters all by normal vaginal delivery.

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ExaminationAfebrileVitally stableUnremarkable examination

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Labs Urine R/M : RBC 100-150 /mm3WBC >200 /mm3PH 6-5Urine C/S CBC & RFT : All within the normal range

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KUB

CT KUB

2x3x1 cm calcification (stone) is noted in the

right side of the urinary bladder away from VUJ.

Adjacent wall thickening with minimal

surrounding fat stranding suggestive of chronic

inflammatory changes.

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Cystoscopy was done showing the finding on the right lateral wall of UB.

DiagnosisIntravesical mesh erosion related to the use

of the TVT sling with stone formation.

Case #2A 76 years old gentlemanComplaining of severe dysuria and frequency.

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3 days history of severe dysuria, frequency and fever.

Gave a history of mild weak stream and frequency. NocturiaHistory of previous AUR 2 months ago.

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No past medical or surgical historyNot on any medicationNo history of stone disease Non smoker

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ExaminationT 39.2BP 150/85HR 91Abdomen was soft, not tender.DRE :

moderate enlarged prostate, tender. No nodules.

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LabsCBC :WBC 13.6Hb 134RFT :Within normal rangeUrine R/M (dipstick)++WBC, +RBC

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Started on Amikacin 1g IV OD and Rocephin 1g IV OD

UltrasoundUrine & Blood culture

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U/S Pelvis70 cc prostatePre void 260 mlPost void 60

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2nd day morning in the hospital the patient was shivering

temperature was 39CPulse 120BP 120/70Perfalgan 1 gm IV was given.Next day morning his temperature was 38.4

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Antibiotic shifted to Meropnem 1g IV/8hVital signs monitoringRepeat CBC, RFT and trace cultures

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Urine C/S : No growthBlood culture : No growth

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TRUS

TRUS without biopsy Prostate volume is 98 ccMultiple hypo-echoic areas of different sizes

involving peripheral and central zones. Suggested of collection.

Aspiration done around 35 mlSample sent for culture

The other day, patient spiked fever of 39C + rigors at night.

Low grade fever persist after aspiration

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CT ABD with IV contrast

Multiple Prostatic abscessesLargest 4x3 cm

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2nd drainage done25 cc aspirated Continued on meronemWas doing well, no fever for 3 daysWent home on Septrin