06/12/2025
Case Presentation
Patient Information
• Age/Sex: 50-year-old male
• Residence: Baghlan Province
• Chief Complaints: Irritative and obstructive lower urinary tract symptoms (LUTS), suprapubic discomfort, intermittent hematuria.
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History of Present Illness
The patient reported a 6–12 month history of progressive LUTS including hesitancy, weak stream, intermittency, nocturia, and a persistent feeling of incomplete bladder emptying.
In recent months, he also developed suprapubic pain, dysuria, and occasional terminal hematuria.
No fever, flank pain, or systemic symptoms.
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Physical Examination
• General condition: Stable
• Abdominal exam: Mild suprapubic tenderness
• Digital re**al exam: Enlarged, smooth, non-tender prostate—consistent with BPH
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Investigations
• Urinalysis: RBC +, mild pyuria
• Renal function: Normal
• Ultrasound KUB:
• Enlarged prostate (~45–60 cc)
• Significant post-void residual urine
• Single bladder stone (~2–3 cm)
• Thickened bladder wall
• X-ray KUB: Radiopaque stone in bladder
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Diagnosis
1. Bladder stone
2. Benign Prostatic Hyperplasia (BPH) causing bladder outlet obstruction
→ Bladder stone likely secondary to chronic urinary stasis due to BPH
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Management
The patient underwent Cystolitholapaxy to fragment and remove the bladder stone, followed by TURP (Transurethral Resection of the Prostate) to relieve bladder outlet obstruction.
A three-way Foley catheter with continuous bladder irrigation was placed postoperatively.
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Postoperative Course
• Recovery was uneventful
• Hematuria cleared with irrigation
• Catheter removed after adequate recovery; patient voiding well
• Marked improvement in urinary stream and resolution of suprapubic discomfort at follow-up
