Medical Treatment of Vesical Stone with BPH in Medically Unstable Patients

Abstract

Vesical calculi of uric acid may be amenable to dissolution with oral alkalinizing medications in patients with BPH in medically unstable patient. Is to determine the value of medical treatment of vesical stones in patients with BPH whose have concomitant medical problems that put them at high risk for surgical intervention. This is prospective study in urological department - Fallujah general Hospital (Anbar , Iraq) between march 2005 and September 2008, Fifty men diagnosed with bladder calculi due to BPH in our hospital with medical problems associated with very high risk factors for surgical intervention like recent myocardial infarction, cerebrovasculr accident , pulmonary diseases etc..The data collected were included age , prostatic size, stone size, medical problem and duration of medical treatment for the stone. Neurogenic bladder; a history of chronic bacteriuria by urea-splitting organisms; foreign bodies in the bladder; bladder diverticula; transplant; augmentation of the bladder and those were not involved in study . we include radiolucent stones only that is most likely to be of uric acid type. The ages of patients were between (50 – 85yr ); the response to medical treatment was higher in those in seventh decade, , it was found that the response was higher in cases when the prostatic size range from 71 ml – 80 ml ;11(37.9%);and from 81- 90 ml; 8(27.5%) , and the response to medical treatment where better when the size of vesical stone between 26 – 30mm [ 7(24.1%)] and 31-35 [7(24.1%)] ,in addition to that the study clarified that the best duration of taking dissolving agent was six weeks where 10 patients (34.4%) had complete response within this period and 9 patients (31%) within 5 weeks , while only 6 patients (20.6%) and 4 patients (13.7%) had respond within 7 and 8 weeks respectively. The present study recommend the followings; High number of vesical stones with BPH are of uric acid content and can be treated conservatively with oral alkalinizing agent. Also, trial of medical treatment of vesical stones with BPH and alpha blockers to avoid the medically unstable patient the risk of general anasthesia