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    An_244814 posted:
    Hi, here are my details:

    age 67
    presently on iv antibiotics
    suspected of sepsis and on urinary cathetor
    psa 8.4, raised bun and creatinine
    massively enlarged prostate (3 times the normal size)
    uretric calculus 8 by 10 mm larger
    curent fever with chills
    Here are my questions:
    1. what r the chances of prostate carcinoma
    2. or septicemia worsoning
    3. is blood culture required
    4. urine culture reports show sterile after 24 hrs
    5. and what is the urgency of surgery
    6. is ivu realy required
    Please advise.
    dnarwat responded:
    I also have RBC and WBC and protein detected in the urine REME
    Basir U Tareen, MD replied to dnarwat's response:
    For now, PSA and prostate cancer are not your biggest concerns. I would first focus on treating the sepsis. If there is an obstructing ureteral stone, that needs to be "unobstructed" and treated when you are medically stable.

    The other priority is to get the kidney function (creatinine) normalized.

    Once these two issues are resolved the challenge then lies in trying to get the foley catheter out and get you emptying your bladder. This may require a combination of an alpha blocker (such as flomax) and a 5 alpha reductase inhibotor (Avodart or Proscar). The latter drug typically reduces the PSA by 50% for men who stay on this therapy.

    Once all the above issues are stable you will need to get a true PSA checked (right now it could be falsely high for many reasons) and at that point if its stil abnormal your urologist may consider doing a biopsy.

    Ultimately if your PSa normalizes and you either do not need a biopsy or a biopsy is done and found to be normal, it sounds like you may require more definitive treatment down the road for the enlarged prostate (such as a TURP, laser, etc.) if the medicines (FLomax finasteride/avodart) are not effective.
    dnarwat replied to Basir U Tareen, MD's response:
    Dear Doctor,

    Thanks for your reply.

    what is the line of treatment for the above case: a) stentingb) or neurectomyc) or removal of prostate may be req at a later staged) n wat r d complications of stenting
    does that later on affect bladder controlor cause reccurent uti
    papa was on traject and magnax for antibiotics and is presently on urinary cathetorbut still got high fever once every daytoday he was finethey will try puttin a stent through urethrahow does that help in hydronephrosis

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