Successful Cystoscopy & Medical Management of Enlarged Prostate with LUTS
PACE Hospitals
PACE Hospital’s expert Urology team successfully performed Diagnostic Cystoscopy under sedation on a 53-year-old male patient from Comoros diagnosed with Enlarged Prostate with Lower Urinary Tract Symptoms (LUTS). The procedure was performed to evaluate the cause of poor urinary flow and lower urinary tract symptoms, assess the urethra, prostate, and bladder, and rule out associated abnormalities such as bladder stones, tumors, or urethral obstruction, thereby helping guide further treatment and improve urinary function and quality of life.
Chief Complaints
A 53-year-old male patient with a body mass index (BMI) of 21 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of poor urinary flow and lower urinary tract symptoms (LUTS). Previous clinical evaluation and ultrasound showed a prostate volume of 28 cc with post-void residual urine (PVRU) of 30 cc and reduced urinary flow rate.
Past Medical History
The patient had a history of persistent penile itching for over 10 years. There were no known drug allergies or significant past medical comorbidities documented.
On Examination
On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Local urological examination revealed a circumcised penis with no evidence of balanitis xerotica obliterans (BXO). Systemic examination findings were otherwise normal.
Diagnosis
Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history, urinary symptoms, and comprehensive clinical examination. He presented with poor urinary flow and lower urinary tract symptoms suggestive of bladder outlet obstruction.
The patient underwent a detailed urological assessment, including prior ultrasound abdomen findings, which revealed a prostate volume of 28 cc with post-void residual urine (PVRU) of 30 cc and reduced urinary flow rate of 10 ml/sec. Considering the patient’s symptoms, further endoscopic evaluation was planned to assess the entire lower urinary tract.
Diagnostic cystoscopy performed under sedation revealed a normal caliber urethra, minimally occlusive prostate, and trabeculated urinary bladder. No bladder stones, tumors, or significant urethral obstruction were identified during evaluation. Laboratory and preoperative assessments were within acceptable limits for the planned procedure.
Based on these confirmed findings, the patient was advised to undergo
Enlarged Prostate with Lower Urinary Tract Symptoms (LUTS) Treatment in Hyderabad, India, under the expert care of the Urology Department, to improve urinary symptoms and quality of life.
Medical Decision Making (MDM)
After a detailed consultation with Dr. Abhik Debnath, Consultant Laparoscopic Urologist, a comprehensive clinical evaluation was conducted focusing on the patient’s presentation of poor urinary flow and lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction. Previous ultrasound findings and uroflowmetry demonstrated reduced urinary flow with mild post-void residual urine, warranting further lower urinary tract evaluation.
Considering the patient’s persistent symptoms, detailed assessment and treatment planning were performed. The patient was offered retrograde urethrogram (RGU) for further evaluation; however, he opted for diagnostic cystoscopy for direct visualization of the entire lower urinary tract. Surgical intervention for the prostate was discussed as a less preferred upfront option due to the potential sexual side effects related to ejaculation, especially considering the patient was unmarried.
Diagnostic cystoscopy under sedation revealed a normal caliber urethra, minimally occlusive prostate, and trabeculated bladder without evidence of bladder stones or tumors. Based on these findings, conservative and medical management with close follow-up was considered the most appropriate approach to manage the patient’s lower urinary tract symptoms and improve urinary flow while avoiding unnecessary surgical intervention.
The patient and his family members were informed about the diagnosis of
Enlarged prostate with Lower Urinary Tract Symptoms (LUTS), the cystoscopic findings, available treatment options, expected outcomes, and the importance of regular follow-up and
urine culture evaluation for continued management and symptom monitoring.
Treatment
Following the decision, the patient underwent treatment for Enlarged prostate with Lower Urinary Tract Symptoms (LUTS) in Hyderabad at PACE Hospitals, under the expert supervision of the Urology team.
During the hospital stay, detailed endoscopic evaluation of the urethra, prostate, and urinary bladder was performed to identify the cause of poor urinary flow and lower urinary tract symptoms. The procedure helped assess the degree of prostatic obstruction and rule out associated abnormalities such as bladder stones, tumors, or urethral narrowing.
The patient received medical management aimed at improving urinary flow, relieving lower urinary tract symptoms, preventing urinary infection, reducing urinary discomfort, and supporting bladder function. Symptomatic treatment and supportive care were provided throughout the hospital stay.
The patient showed stable recovery with improvement in symptoms and remained clinically stable throughout the hospital stay.
Discharge Medications
At the time of discharge, the patient was prescribed medications for infection prevention, pain relief, gastric protection, urinary alkalization, and improvement of urinary flow and lower urinary tract symptoms associated with benign prostatic enlargement.
Emergency Care
The patient was advised to contact the emergency ward at PACE Hospitals in case of fever, abdominal pain, burning urination, blood in urine, difficulty passing urine, worsening urinary symptoms, or any unusual complaints requiring urgent medical attention.
Review and Follow-up
The patient was advised to return for a follow-up consultation with the Urologist in Hyderabad at PACE Hospitals after 3 days, along with urine culture reports for further evaluation and continued management.
Conclusion
This case highlights the successful diagnostic evaluation and management of Enlarged prostate with Lower Urinary Tract Symptoms (LUTS) in a 53-year-old male patient. Diagnostic cystoscopy under sedation helped assess the lower urinary tract and rule out significant urethral obstruction, bladder stones, and bladder tumors.
The patient was discharged in stable condition with medical management, follow-up advice, and continued care aimed at improving urinary symptoms and overall quality of life.
Importance of Endoscopic Evaluation in Lower Urinary Tract Symptoms Management
A comprehensive urological evaluation plays an important role in identifying the underlying cause of lower urinary tract symptoms and guiding appropriate treatment decisions. Careful clinical assessment combined with imaging and endoscopic evaluation helps differentiate benign prostatic enlargement from other conditions such as urethral strictures, bladder stones, tumors, or significant bladder outlet obstruction. In this case, diagnostic cystoscopy provided direct visualization of the urethra, prostate, and urinary bladder, allowing accurate assessment of the lower urinary tract.
Minimally invasive endoscopic procedures such as cystoscopy offer precise evaluation with minimal discomfort, reduced tissue trauma, and faster recovery. Early diagnosis and appropriate medical management by the urologist/urology doctor helps improve urinary flow, relieve bothersome urinary symptoms, and reduce the risk of long-term bladder dysfunction. Individualized treatment planning and regular follow-up remain essential for improving patient comfort, urinary function, and overall quality of life in patients with benign prostatic enlargement and lower urinary tract symptoms.
Frequently Asked Questions (FAQs)
What are lower urinary tract symptoms (LUTS)?
Lower urinary tract symptoms (LUTS) refer to problems related to storing or passing urine. Common symptoms include poor urine flow, difficulty starting urination, frequent urination, urgency, and incomplete bladder emptying. These symptoms are commonly seen in older men with an enlarged prostate.
What causes poor urinary flow in men?
Poor urinary flow can occur due to an enlarged prostate, urethral narrowing, bladder problems, or urinary tract obstruction. In older men, benign enlargement of the prostate is one of the most common causes. Weak bladder muscles may also contribute to symptoms. Medical evaluation helps determine the underlying condition.
Why was cystoscopy advised in this patient?
Cystoscopy was advised to directly examine the urethra, prostate, and urinary bladder. It helps identify the cause of poor urinary flow and rule out conditions such as urethral stricture, bladder stones, tumors, or severe obstruction. The procedure provides an accurate visualization of the lower urinary tract, which helps to guide appropriate treatment planning.
Can cystoscopy detect bladder tumors or stones?
Yes, cystoscopy is commonly used to detect bladder stones, tumors, blood clots, urethral narrowing, and other abnormalities inside the urinary tract. It provides direct visualization of the bladder and urethra. This makes it more accurate than some imaging tests in certain conditions. It is an important diagnostic procedure in urology.
What does a minimally occlusive prostate mean?
A minimally occlusive prostate means the enlarged prostate is causing only mild blockage to urine flow. Even mild enlargement can sometimes produce bothersome urinary symptoms. The condition may be managed with medications and regular monitoring instead of immediate surgery.
What is a diagnostic cystoscopy procedure?
Diagnostic cystoscopy is a minimally invasive procedure in which a thin camera-equipped instrument is passed through the urethra into the bladder. It allows the urologist to examine the urinary passage, prostate region, and bladder internally. The procedure is commonly performed under local anaesthesia or sedation. It usually takes a short time to complete.
Is cystoscopy painful?
Cystoscopy is generally well tolerated and causes only mild discomfort in most patients. Sedation or local anaesthesia is often used to reduce pain during the procedure. Some patients may experience mild burning during urination for a short time afterwards. Serious pain or complications are uncommon.
What does a trabeculated bladder mean?
A trabeculated bladder means the bladder wall has become thickened due to long-standing pressure during urination. This commonly occurs in patients with chronic urinary obstruction, such as an enlarged prostate. The bladder muscles work harder to empty urine over time. Early treatment may help prevent worsening bladder dysfunction.
Why was surgery not immediately advised for this patient?
Surgery was not immediately advised because cystoscopy showed only minimal prostate obstruction without major blockage. The patient was also counselled regarding possible side effects of prostate surgery. Medical management and regular follow-up were considered more appropriate initially. Treatment decisions were individualized based on the patient's symptoms and clinical findings.
What lifestyle changes help improve lower urinary tract symptoms?
Lifestyle measures such as limiting caffeine and alcohol, avoiding excessive fluid intake at night, maintaining a healthy weight, and following regular bladder habits may help improve symptoms. Timely treatment of urinary infections and regular follow-up with the urologist are also important. These measures can improve urinary comfort and quality of life.
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