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Volume 12 Issue 4 ( October-December ) 2023

Original Articles

A Clinicoradiological Study With Diagnostic Value Of PSA And Its Management Strategy
Dr. Anant Jain, Dr. Rucha Rampalliwar, Dr. Dhananjay Naik, Dr. P.Jain, Dr. Karan Dholu, Dr. Anubhav Mishra

Background: Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha-adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organsBenign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) commonly affect older men. Age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause BPH development. The diagnosis of BPH hinges on a thorough medical history and focused physical examination, with attention to other conditions that may be causing LUTS. Digital rectal examination and urinalysis should be performed. Other testing may be considered depending on presentation of symptoms, including prostate-specific antigen, serum creatinine, urine cytology, imaging, cystourethroscopy, post-void residual, and pressure-flow studies. Serum prostate-specific antigen (PSA) is used for the screening and early detection of prostate cancer. We are, however, confronted with the dilemma that a significant number of unnecessary biopsies are unavoidable especially in the serum PSA range of 4 to 10ng/ ml. It has been reported that age-specific PSA reference ranges, PSA velocity, PSA molecular forms and volume-adjusted PSA are valuable tools to improve specificity for early diagnosis of prostate cancer. Results: In our study as per diagnosis by clinical findings Out of 100 patients, 56 patients were diagnosed as BPH, 4 as carcinoma prostate, 18 as stricture urethra, 6 as UTI, 8 as calculus disease of lower urinary tract, 2 as phimosis, 4 as neurogenic bladder and 2 patients as bladder neck hypertrophy.On USG, Out of 100 cases, 56 patient’s findings had enlarged prostate, 8 had calculus disease (out of which 6 were vesical and 2 were urethral calculus), 3 had cystitis (bladder wall thickened) and in rest 33 patients there were no abnormalities.Out of 100 patient 28 had PSA levels between 4.1-8 ng/ml, 4 had PSA levels greater than 8 ng/ml. Conclusion: Urinary retention is more common in men than in women and more commonly severe in age group more than 40 years.In men BPH is the most common cause of urinary retention followed by stricture urethra and calculus disease. In children, common causes are UTI and phimosis. In women, common causes are UTI and calculus disease Ultrasonography is a very important investigation to rule out the definitive causes of urinary retention, whereas other radiological investigations like Xray KUB and MCU/RGU are helpful in diagnosing calculus diseases and stricture urethra.In BPH patients PSA level also increases but in lower range and in case of CA prostate PSA level increases in the higher range.Catheter trail should be given on the 3rd/5th day after initial treatmentSurgical intervention is the method to treat the failed catheter trial in cases of retention of urine, conservative medical management can be imposed in the patients where catheter trial is successful.

 
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