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Urodynamic evaluation and treatment selection in male patient with lower urinary tract symptoms and small prostate: a case report

Introduction: Lower urinary tract symptoms (LUTS) have a high prevalence in men and include urgency, straining and sense of incomplete bladder emptying. They can be caused by urological and neurological disorders. Case report: This case describes a 49-year-old male patient with dominant storage LUTS that lasted for the past 12 months. Although he was prescribed tamsulosin, he still reported urgency, weakened urination stream, bladder pain at the beginning of the urination in the morning and sense of incomplete bladder emptying. Consequently, he was admitted for urodynamic evaluation of LUTS at the Department of Urology, University Hospital Center Osijek. Ultrasound showed 180 ml of bladder post-void residual (PVR) volume and prostate volume of 30 g with mild intravesical protrusion. Cystometry showed reduced cystometric capacity (134 ml) and bladder compliance (2 ml/cmH2O) with detrusor overactivity (DO). Pressure-flow study showed high bladder outlet obstruction index (149), indicating urinary obstruction. After the urodynamics, there was no PVR. Five days later the patient was hospitalized for urinary tract infection and PVR. He was treated with antibiotics, insertion of an indwelling urethral catheter. After 3 weeks of antimuscarinic therapy for DO, urethrocystoscopy in general anaesthesia was performed. It showed the enlargement of the middle prostatic lobe elevating the bladder trigone and we indicated its resection. After the surgery PVR was 0 ml. Conclusion: High PVR in men is usually not associated with small prostate. It is important to perform a pressure-flow study to find out the exact pathophysiology of LUTS and select the most appropriate treatment.

Urodynamics ; Lower urinary tract symptoms ; Prostate ; Urinary retention

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