Disturbi della sfera sessuale, la varicocele e l'ematuria (presenza del sangue nelle urine)
Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We BPH ematuria macroscopica the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.
BPH ematuria macroscopica prostatic hyperplasia BPH is a common condition that affects many aging men and it may be associated with significant quality of life issues. We report the first case, to our knowledge, of a man with GPH and without voiding symptoms, who presented sudden gross hematuria and hypovolemic shock.
An afro-descendent, year-old man was admitted to the emergency room with painless macroscopic hematuria for 5 BPH ematuria macroscopica without clots. The patient denied any prior episodes of hematuria and did not complain of voiding symptoms.
There was no history of smoking, alcohol abuse, severe comorbidities the patient was treated with angiotensin-converting enzyme inhibitor to control mild arterial hypertensionor use of anti-coagulants or blood thinners. On physical examination the patient BPH ematuria macroscopica dehydrated and with pale mucosa. Abdominal palpation did not reveal any evident masses. The digital rectal examination revealed a large prostate with an estimated volume significantly greater than g, but with benign consistency and without nodules.
The individual underwent prompt bladder catheterization with large catheter and vesical irrigation with saline solution. He also had acute renal insufficiency, with creatinine and urea levels of 1. The patient underwent immediate volume resuscitation with saline and blood transfusion. An abdominal ultrasound was performed when the patient was hospitalized in the emergency room, which demonstrated moderate bilateral hydronephrosis and a pelvic mass measuring 15x16x16cm.
The computerized tomography CT scan had confirmed the evidence of urinary obstruction and a large pelvic mass representing the prostate Figure 1. Prostatic specific antigen PSA levels measured after lower urinary tract BPH ematuria macroscopica were as high as Therefore, prostate trans-rectal ultrasound guided biopsies were performed to assess the possibility of a prostate adenocarcinoma or sarcoma. No BPH ematuria macroscopica of malignancy was identified in the biopsy specimens.
Subsequently, the patient underwent an uneventful open trans-vesical prostatectomy TVP. The procedure time was about minutes and the no further blood transfusions were required.
The prostatic adenoma, extirpated as a single piece, measured 17x16x Final pathological analysis revealed a whitish, firm and multinodular surface with cysts and diffuse hemorrhagic areas compatible with prostatic nodular hyperplasia with multiple anemic infarction foci and glandular squamous metaplasia.
At 1 year of follow-up, the patient returned to clinic with normal renal function, satisfactory urinary flow, and complete continence, although currently he is on treatment with anti-muscarinic medications due to urinary urgency.
It is well-known that anatomic measurements of the prostate do not adequately distinguish patients who BPH ematuria macroscopica medical care from those who do not. However, it is unexpected for a man with such a large gland to remain asymptomatic prior to admission to the emergency room with hematuria BPH ematuria macroscopica class III hemorrhagic, and hypovolemic shock, which require urgent blood transfusion.
Gross hematuria is an uncommon complaint in men with enlarged prostate, which is rarely seen as an initial presentation.
Prior series report an prevalence rate of approximately 2. The exact etiology of bleeding in men with enlarged prostate is unclear BPH ematuria macroscopica may be attributable to increased microvessel density level 4 and vascular endothelial growth factors over-expression.
BPH ematuria macroscopica to ensure malignancy status prior to initiate definitive treatment are of utmost importance given its potential impact on therapeutic choice. Because of the size of the prostate, the sarcoma was another possibility that needed to be excluded, 7 BPH ematuria macroscopica such affection rarely induces PSA elevation. BPH ematuria macroscopica urinary tract BPH ematuria macroscopica and gross hematuria leading to hypovolemic shock are well-known indications for BPH surgical treatment.
Although minimally invasive approaches such as robot-assisted simple prostatectomy 8 can be used for the treatment of BPH, the open surgery remains the gold standard procedure for benign, large volume, prostatic hyperplasia. Sutherland et al. Similar to others, 12 we consider BPH ematuria macroscopica prostatectomy as the primary recommended treatment option for GPH. For this reason, a suprapubic open trans-vesical prostatectomy was performed.
Operation time was short and no major complications occurred. GPH is an extremely rare condition. O toque retal revelou próstata aumentada com volume estimado significativamente maior que g, porém com consistência benigna e sem nódulos. Realizou-se, no serviço de emergência, ultrassom abdominal, que mostrou hidronefrose bilateral moderada e massa pélvica medindo 15x16x16cm.
Em seguida, o paciente realizou prostatectomia transvesical aberta PTA. A etiologia exata de sangramento em homens com próstatas aumentadas é indefinida, porém pode ser atribuída ao nível da densidade de microveias 4 e a fatores de crescimento do endotélio vascular BPH ematuria macroscopica. O tempo de cirurgia foi curto e sem ocorrência de grandes complicações. National Center for Biotechnology InformationU.
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Find articles by Antonio Carlos Lima Pompeo. Author information Article notes Copyright and License information Disclaimer. Received Jul 7; Accepted Apr Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Open in a separate window. Figure 1. Computerized tomography scan showing urinary obstruction hydronephrosis and a large pelvic mass representing the prostate. Figure 2. The prostatic adenoma, extirpated as a single piece, measuring A case of giant prostatic hyperplasia. Do prostate size and urinary flow rates predict health care-seeking behavior for urinary symptoms in men?
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