OAB Real life Cases

• Dr Clarence Lei Chang Moh, FRCS Urol• Consultant Urologist, Kuching• clarencelei@gmail.com

BORNEO REGIONAL UROLOGY WORKSHOP,

Kota Kinabalu, 9-10 July 2011

Tan Sri BN (DOB: 1938); 72 yrsHBP, IHD, (PTCA 2004 SJMC), gout, psoriasis,

IBS

Urology/CL: 23.10.99 (65 yrs)

- Urgency with episode UUI @

Board Meeting

- Freq 2H, but N 1x

- Flow good, no pain, no H wants some medication, important meeting

Nursing Assessment BP: 187/103

Further Mx

• Examine pt? History usu sufficient

DRE: uncomfortable for dr & pt !!

• Any Ix ??

• or just give Vesicare??

What Ix?

1. Urine FEME (RM13) or culture (RM45)

2. PSA – who need PSA?

3. U/S UT – any evidence ?

4. TRUS – urologist

5. Uroflow – most GH in UK, urologist, see

What Ix?

1. Urine - N

2. PSA - 0.38; 0.32 (2.3.10)

3. U/S UT - Normal

4. TRUS - 30 mls

5. Uroflow - see

TREATMENT

1. Tolterodine 2 mg bd, physicians (PTCA 2009)

2. Tolterodine 2 mg PRN

3. Resign from some boards

4. ? CVS

OAB: Vesicare (+ PDE5I + Nebido)

CCY, corporate pay, DOB: 1932, 78 yrs

IHD, AAA 5.4 cm., colonic polyps, spine op, ED

Urology/CL 27.7.04 - urgency

(72yrs) - frequency 2-4 hrs (MahJ)

- N 2-4x

- flow st good, full bladder

BP: 190/98, HR: 80

DRE: Normal

What Ix?

1. Urine FEME, C&S (N ?)

2. PSA (1.91 ?)

3. Ultrasound urinary tract (N ?)

4. TRUS (37.5 cc ?)

5. Bladder volume (20 cc)

6. Uroflow (see tracing)

Comment on Uroflow:…….

UROFLOW IS typical of ………….

Patient says flow is GOOD, IPSS vs QOL

TREATMENT

1. Tolterodine SR 4 mg ? Risk AUR

? 2. Alfuzosin XL 10 mg

? 3. Dutasteride 0.5 mg WHO NEEDS IT?

? 4. PDE5 I ? Which one ? Corporate payTRIPLE meds: TKH, HAJ, MA, OBC DOUBLE: LTT

Mr DS, DOB: 1925, 84 yrs

LBP/R THR / analgesic. CRF, creat 229/cataracts/

colonic polyps

Urology/CL: 8.6.2001- Urgency, UUI

(75yrs) - Nocturia 3x

- Good flow

PMH: TUR prostate abscess 18.4.98 (PSA 14)

Stone op: RK, S’pore 98, ESWL, London, SJMC

bladder SGH 1980.

DRE: Normal

Any more tests or just give Vesicare??

Does he need the uroflow??

What Ix?

1. Urine: Protein 2+, C&S: Neg.

2. US: BK echogenic with cysts, RK LP

stone 14 mm

3. PSA: 24.5 (22.8.2001)

4. TRUS: 25 cc hypoechoic areas both

5. Uroflow: see tracing

PROGRESS: PSA problem

PSA raised 30: biopsies

4.98 - biopsies prostate

2.4.02 - No prostatitis, suspicious

2.9.03 - PSA 40

TREATMENT ?

Anti-cholinergics (tds, then OD): No money!

(since 10.6.2001, esp long flights)

Prostate biopsy 23.10.03: Ca P (3+3) both

3 monthly FU, sc Zoladex last 17.11.09

PSA 10.6.01: 0.56

Dato Seri AHL, DOB 1933 (76 yrs)

ED, DM, HBP, PTCA @ SGH 12/05

Urology/CL: 10.10.2001

Day 1 - 2 hr, N 4 - 5x

Seen GP London

DRE: normal

What Ix GP?

1. Urine FEME

2. Urine FEME, C&S

3. Blood BS BUSE

4. Blood BS BUSE PSA

What Ix Specialist?

1. Ultrasound urinary tract ?

2. Transrectal ultrasound ?

4. Cystoscopy ??

5. Uroflow and bladder scan, max. 19.3 ml/s

Management

OAB

Anti-cholinergic bd, N Med Spec Ctre

GH since 10.10.01!

FOLLOW-UP:

DATE 21.9.05 10.8.09 23.10.0930.12.09 21.7.10PSA 1.95 4.49 7.44 5.9 6.47

What Next?

1. Follow-up - ? 6 mthly

2. TRUS (14.8.09, 21.7.10: N)

3. TRUS Biopsy

4. If (+), what next?

5. Urine FEME, C&S

Antibiotics for Prostate

• Types

• duration

Prostatitis

Urine leuco(+), C&S Neg.

23.10.09 - Ofloxacin 200 mg bd x 1 month

21.07.10 - Doxycycline 100 mg bd x 1 month

Antibiotics: SS, K, RT

Thank you !