Case
atonic bladder

Age: 65
Sex: Male
Race: arabic

History
History of present illness:
the patient was normal civil pilot until one year ago when accidentally discovered ultrasonically & by CT-scan a huge central abdominal cystic lesion.!! then under G.A. & after putting Foley catheter about nine litters of urine was evacuated so the abdominal distention was relieved..the problem now is inability to urinate without using a catheter..all investigations were normal.!! is there is any chance of cure? & how??

Medical History:
he was hypertensive before the bladder was evacuated,,now he has normal blood pressure.
not diabetic..

Past surgical history:
negative

Allergies:
negative

Medications:
now he is on a prophylactic dose of oral (antibiotic)norfloxacine.

Family history:
negative

Social history:
was consuming a alcohol & smoker until one year ago..


Physical Exam
General:
normal

Temperature:
normal

Heart rate:
normal

Blood pressure:
normal

Respiratory rate:
normal

Oxygen saturation:
within normal range in this age group.

Head, ears, eyes, nose & throat:
normal

Neck:
normal

Chest:
normal

Cardiovascular:
normal

Abdomen:
normal

GU:
cant urinate without using a catheter..

Rectal:
was suffering from bleeding hemorrhoid before evacuation of the urinary bladder,,now there is no problem.

Neurological:
normal

Skin:
normal

Laboratories:
pus cells,R.B.C.s& epithelial cells in urine.

Radiology:
normal

Plan of treatment:
training of urinary bladder by intermittent catheterization..(opening the catheter every four hours to evacuate then close it again)..

Results of treatment:
no progress till now apart from felling of urgency sometimes relieved by opening the catheter..

Discussion:
after excluding the neurological & organic causes of a tonic bladder it seems that the patient was ignoring the feeling urgency for along time-over years- during work..




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