A patient in India is sufferring from urinary problem--

A patient in India is sufferring from urinary problem-- urine passing is difficult,accompanied with pain and he has to takeout urine himself every six hours through a bag and tube fixed through his abdomen by the doctors. The doctors in India told him that he has no other alternative exceping using the same method of taking urine out throughout his remaining life.He wants to know whether anything can be done--surgery or medicine etc. I am giving below his discharge report from his Hospital.
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Discharge report
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'''' CHRISTIAN MEDICAL COLLEGE
VELLORE - 4
DEPARTMENT OF UROLOGY UNIT II
MEDICAL REPORT
Consultants Email***@******.***
Nitin S Kekre MS, DNB (Urol) Prof & Head of Urology Tel 0416-2282111
Santosh Kumar MS, MCh, Professor Fax (0416)(###) ###-####2232103
Shanmugasundaram R MS, MCh Associate Professor
Rajiv Paul Mukha MS.MCh Assoc Professor
Nirmal T.J MS, M.Ch Assistant Professor
Pradeep MS, M.Ch Assistant Professor
*******************
Name : RAMAKRISHNA K.V Hospital Number 131431F
Age : 50 Sex : Male Visit Date : 21-Mar-2012
Address : FLAT NO. 405, SAIKYATHI APARTMENT
R.R. PET
ELURU WEST GODAVARI ANDHRA PRADESH Pincode 534002
DIAGNOSIS : LUTS for evaluation.
HISTORY
INVESTIGATIONS
02-Mar-2012 P.C.V. 39.6 %
02-Mar-2012 MANUAL URINE MICROSCOPY & CRYSTALS Edited
WBC nil
RBC nil
EPITHELEAL CELL prt
CASTS nil
CRYSTALS nil
02-Mar-2012 CREATININE 1.18 mg%
02-Mar-2012 GLUCOSE RAN PL 89 mg%
02-Mar-2012 C/S URINE COMMON
NO PUS CELLS, NO BACTERIA
No Growth
IMAGING
MICTURATING CYSTOURETHROGRAM (MCU): 08.03.2012:
SCOUT: 1mm- 4mm distinct round opacities with rounded lucencies -
phleboliths
PENILE URETHRA: nil significant
BULBAR URETHRA:
* Short segment tight stricture proximal bulbar urethra
MEMBRANOUS URETHRA: nil significant
PROSTATIC URETHRA: elongated prostatic urethra
URINARY BLADDER: delay and inadequate opening of the bladder neck
VESICOURETERIC REFLUX: absent
VOIDING PHASE: difficult initiation and poor stream
POST-VOID RESIDUE: moderately significant
BONES AND JOINTS: nil significant
IMPRESSION: A 50 year old gentleman with long standing voiding dysfunction,
MCU done shows:
1. Delayed and inadequate bladder neck opening with poor stream of urine-
suggestive of bladder neck obstruction
2. Short segment tight proximal bulbar urethra
3. Elongated prostatic urethra - prostatomegaly needs to be ruled out
4. Moderate post void residue.
PROCEDURE DONE
UROFLOWMETRY: Qmax 14.2 ml/sec Voided vol 339 ml
Post void residue 100 ml.
CMG:
Filling phase: Filling started at the rate 15-20 ml/min. Patient had normal
sensations. Normal compliance. Bladder filled up to 478 ml. Detrusor overactivity
absent. Compliance normal.
Voiding Phase: Voiding was inconclusive as he strained a lot during voiding. He was
very anxious during the procedure ? performance anxiety. He was trying to pass urine
with abdominal straining. Detrusor pressure reading showed contractile detrusor. The
element of obstruction cannot be ruled out.
Discussion: In view of patient's anxiety regarding voiding and high PVR he is a CIC.
He is also started on alpha blockers.
RECOMMENDATIONS
CIC every 6 hourly after voiding.
Tab. Cefpodoxime 200 mg twice daily for 7 days.
Tab. Veltam 0.4 mg once daily at bed time for 3 months.
Review in Urology Unit II OPD at 3 months with PVR report.
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You can book advance appointment for new and revisit patients by calling 0416-2288000
/3078000 from Monday to Saturday between 7.00 am to 9.00 pm. Appointments over the
phone are only done with payments. Payment for the phone appointments can be done
with any valid credit card or debit card or CHRIS card (issued by CMC).
You can also book appointments by emailing at***@******.*** and fix up
an appointment before coming here. Our outpatient clinic days are Tuesday / Friday.
Nitin S Kekre (Prof & Head of Urology)
MS, DNB (Urol)
DEPARTMENT OF UROLOGY UNIT II
___________________________________________________________________________
Kindly inform and advise.
My email address:- ***@******.***
Patient's email address:-***@******.***