Case Report

Urinary Retention ec Benign Prostatic Hyperplasia

Clara Dian Pistasari Putri1, Marta Hendry2
1

Clinical Senior Clerkship, School of Medicine, Medical Faculty of Sriwijaya University, Dr.
Mohammad Hoesin General Hospital, Palembang
2
Department of Urology, School of Medicine, Medical Faculty of Sriwijaya University, Dr. Mohammad
Hoesin General Hospital, Palembang

Background
Urinary retention is the inability to empty the bladder to completion 1. Causes of urinary
retention are numerous. The most common cause of urinary retention is obstruction
which is caused by benign prostatic hyperplasia 1Benign Prostate Hyperplasia (BPH)
which is defined as the proliferation of prostatic stromal cells which results in an enlarged
prostate gland. Its incidence is age related. The symptoms of BPH can start early as age 30.
By the age of 50, up to 50% of men exhibit histologic evidence of BPH symptoms and these
symptoms tend to increase with age.
Clinical Presentation

A 63 year-old-male patient came to the emergency room of Mohammad Hoesin

General Hospital in Palembang with the chief complaint of unable to urinate. Since 6
months ago patient sometimes complaint difficult to void, had to push to begin
urination, decreased force and caliber of stream, stopped and started again when
urinated, post void dribbling. Voiding at night sometimes more than 3 time at night.
He was difficult to postpone urination and had sensation of incomplete bladder
emptying. Pain in lower back abdominal (-), pain in his genitals (-). Nausea (-),
vomited (-). Bloody urination (-), suppurative urination (-), stone in urine (-), defecate
(+) normal, fever (-), trauma (-). The patient didnt see the doctor due to the
complaints still could relieve.
Two days before admission, the patient could not urinate. He felt strain and pain
because of the full of bladder and bulging in the suprapubic. He came to emergency
room of Mohammad Hoesin hospital.
The increasing of leucocyte (15,4. 103/mm3) and ESR (40 mm/hour) of this
patient is caused by the static flow of urine which can lead to infection. The renal
function based on the ureum and creatinin level is normal. USG is confirmed the
enlargement of the prostate and no abnormal form of renal. The patient has done
TURP and the result of pathological sample is Benign Prostatic Hyperplasia
Conclusion
This case has reported a patient with urinary retention ec obstruction ec BPH. BPH is
the most common cause of obstruction in male. The surgical procedure for BPH is
Transurethral resection of the prostate (TURP). Therefore, the succesful management
and treatment can improve quality of life for this patient
Keywords: urinary retention, lower urinary tract, prostate, benign prostate
hyperplasia
1

transition zone3. BPH is the most common

Background

Urinary

retention

is

the

inability to empty the bladder to

completion1. It may be acute, chronic,
or acute on chronic. In chronic urinary
retention, it may be able to urinate, but
it has trouble starting a stream or
emptying the bladder completely. It
may urinate frequently, feel an urgent
need to urinate but have little success,
feel still have to go to the toilet even
after have finished urinating. Chronic
urinary retention may not seem life
threatening, but can impact in quality
of life. In acute urinary retention, it
totally cant urinate at all even though
the bladder is full. Acute urinary
retention is a medical emergency
requiring prompt action1.
Causes of urinary retention are
numerous and can be classified as
obstructive,

infectious

and

inflammatory, neurologic, or other1.

Retention is >10 times more common

in men than in women The most

common cause of urinary retention is
obstruction which is caused by benign

benign tumor in men, and its incidence is

age-related4. The prevalence of histologic
BPH in autopsy studies rises from
approximately 20% in men aged 4150, to
50% in men aged 5160, and to over 90%
in men older than 804. The etiology of
BPH is not completely understood, but it
seems to be multifactorial and endocrine
controlled. The etiology is multifactorial
with

prostatic

hyperplasia

to the proliferation of smooth muscle and

cells

within

endogenous

the

risk

of

developing

symptoms.

Hyperplasia in the prostate is stimulated

by androgens. The most potent androgen
is dihydrotestosterone, which is converted
from testosterone by the enzyme 5-alpha
reductase. The hyperplasia includes both
smooth

muscle

cells

and

glandular

connective tissue. In addition, smooth

muscle in the prostate may be further
contracted by the sympathetic nervous
system

perpetuating

obstruction,

known

as

any

existing

the

dynamic

mechanism of obstruction. The increase in

the bulk of the prostate causes obstruction
by the static mechanism6.
The enlarged gland has been

(BPH) is a histologic diagnosis that refers

epithelial

age,

androgens and prostate volume increasing

prostatic hyperplasia1.
Benign

advancing

the

proposed to contribute to the overall

lower

urinary

tract

symptoms

(LUTS)5. The most common LUTS are

prostatic

urinary

frequency,

urgency,

and

He went to emergency room of

hesitancy, weak stream, and nocturia5.

Banyuasin

district

hospital

and

got

inserted urinary catheter in his urethra.

Clinical Presentation

The doctor who examined said that his

A 63 year-old-male patient came to

prostate had enlarged and need surgical

the emergency room of Mohammad

therapy. But, the patient felt well and went

Hoesin General Hospital in Palembang

home with urinary catheter released.

with the chief complaint of unable to

urinate. Based

on autoanamnesis

of

present illness, since 6 months ago patient

sometimes complaint of the

difficulty to

void, had to push to begin urination,

decreased force and caliber of stream,
stopped and started again when urinated,
post void dribbling. Voiding at night

Two days after, the patient still

could not urinate. He felt strain and pain
because of the full of bladder again and
bulging in the suprapubic. He came to
emergency room of Mohammad Hoesin
hospital and got inserted persistent urinary
catheter in his urethra.
From history of of past illnesses:

sometimes more than 3 time at night. He

was difficult to postpone urination and had

trauma

sensation of incomplete bladder emptying.

instruments inserted to urethra (-). No

Pain in lower back abdominal (-), pain in

history of urinary infections. No history of

his genitals (-). Nausea (-), vomited (-).

prostate, bladder, penis, urethra operation.

Bloody urination (-), suppurative urination

No history of urinary stone. No history of

(-), stone in urine (-), defecate (+) normal,

Diabetes Mellitus and CVD. History of

fever (-), trauma (-). The patient didnt see

family disease which had complaint same

the doctor due to the complaints still could

as the patient in family denied.

relieve.

(-),

From

history

physical

of

using

any

examination,

admission

general examination was normal. On

patient complained very uncomfortable in

local examination, abdomen and CVA

every urinating. The complaints were

region

more severe. He had pushed to begin

External genitalia examination, from

urinate but could not void. He felt strain

inspection, the genitals and scrotum

and pain because of the full of bladder.

are normal. There is no urethra bloody

Seven

days

before

was

within

normal

limit.

or suppurative discharge and had been

circumcised.

On

rectal

toucher
3

examination TSA good, enlargement

of

the

prostate

with

rubbery

consistency and smooth surface. The

mucosa is good, feces (+), blood (-).
Laboratory

examination

revealed a normal of hemoglobin (16,6

gr/dL) and hematocryte (46vol%).
Increasing leucocytes 15,4. 103/mm3,
ESR 40 mm/hour.

Ureum is 23

mg/dL. Creatinine is 1,2 mg/dL. Urine

Figure. Ultrasonography

Culture Epitel (-), Leucocyte : 20-25,

Cylinder : (+)

The treatment for this patient is

From USG examination, no

Trans Urethral Resection of Prostate.

abnormalities in right and left kidney,

The histological sample of the the

no enlargement of kidney, pelvis

resection

calices

not

Widening

was

examined

by

widening,

no

stone.

Pathologist. The result was Benign

prostate

41

cm.

Prostate Hyperplasia. Prognosis for

this pastient, quo ad vitam is bonam
and quo ad functionam is dubia ad
bonam
Discussion
This case is reporting a 63 year-old-man
came to emergency room Mohammad
Hoesin Hospital with chief complaint
unable to urinate even though the bladder
was full and bulging in suprapubic. This
condition was an acute urinary retention
which need medical emergency requiring
prompt action. In the emergency room, the
patient got inserted persistent urinary
catheter in his urethra.

Based on autoanamnesis, the

Prostate

(TURP).

This

involves

patient has irritative and obstructive

removing the prostatic urethra and

symptom of Lower Urinary Tract

coring the prostate, which creates a

Symptoms

(LUTS).

channel for that patien to void through.

symptom

is

The

caused

iritative
by

the

hypersensitivity of detrusor urinae

TURP is the gold standard for surgical

management of BPH

muscle. The bladder is not fully empty

This patient has done TURP.

when urination or the enlargement of

The histological sample is examined;

the prostate lead to the increasing of

the result confirmed it is BPH.

bladder contraction. Hence, he feel

urgency and increasing the frequency

Conclusion

in urination, nocturia, and dysuria. The

obstructive symptom is caused by the
failure of detrusor urinae muscle in
contraction.

The

symptoms

hesitancy,

weak

void

incomplete

emptying,

are

stream,
and

also

intermittency of urination.
The increasing of leucocyte
(15,4.

103/mm3)

and

mm/hour) of this patient

ESR

(40

might be

caused by the static flow of urine

which can lead to infection. Urine
Culture Epitel (-), Leucocyte : 20-25,
Cylinder : (+). The renal function
based on the ureum and creatinin level
is normal. USG is confirmed the
enlargement of the prostate and no
abnormal form of renal.
The enlargement of the prostate
needs surgical therapy. The most

This case has reported a man

above 50% years old with a chief
complaint of problem in voiding.

The

complaints are the manifestation clinic of

LUTS. From the physical examination:
rectal toucher showed there was an
enlargement of the size of prostate had a
smooth surface and rubbery consistency.
Besides

that,

from

the

laboratory

examination, increasing leucocytes 15,4.

103/mm3 and ESR 40 mm/hour. Urine
Culture Epitel (-), Leucocyte : 20-25,
Cylinder : (+). From USG, confirm that
there was enlargementof prostate. The
patient got surgery treatment, TURP. The
sample examined by the pathologist and
the

result

was

Benign

Prostate

Hyperplasia.
References

choice surgical procedure for BPH is

Transurethral

Resection

of

The

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Kalejaiye,
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Urology : Diagnosis and Therapy

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EGC

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