Multiple Severe Nonmalignant Urological Pathologies Management in Frail Elderly Patient: A Case Report

Graziani D, Suraci PP, Fuschi A, Pastore AL*, Al Salhi Y, Scalzo S, Antonioni A, Rera OA, Valenzi FM, Sequi MB, Erra L, Benante P, Di Gregorio G and Carbone A

Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

^*Correspondance to: Pastore Antonio Luigi 

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Abstract:

Introduction: In the last decade’s scientific progress, social and economic development brought to improvements in quality of life and life expectancy. Elderly are considered active and important part of our society. Often elderly are affected by multiple and severe pathologies that require treatments. In our department we treated a 79 years old subject with multiple bilateral renal cysts, bladder urolithiasis, and benign prostatic hyperplasia with an overall severe decrease of quality of life. Materials and Methods: To measure the impact of treatments, the patient was investigated with a self-administered Quality of Life questionnaire before and after every surgery. IPSS and OABqSF questionnaires were submitted before first surgery and after prostate surgery. Values of PSA, Creatinine, eGFR, BUN were collected before and after every surgery. Bladder ultrasound and uroflowmetry were performed before first surgery and 3 months after prostate surgery. The patient came to our attention, presenting severe LUTS and left flank pain. CT scan described multiple and bilateral renal cysts (>9 cm) and renal stones (>2 cm), ureteric hydronephrosis (14 mm in pelvic tract), bladder with multiple diverticula, and a huge stone (40 mm × 45 mm), enlarged prostate with third lobe. Prostatic MRI scan described a glandular volume of 93.95 cc without suspicious nodular lesions (PIRADS 2). We treated first bladder stone through an endoscopic Cystolithotripsy, followed by HoLEP and ureteral stenting. Lastly, we decided to treat left renal cysts because of their symptomatology and obstructive nature through laparoscopic surgery. Results: We observed a significant improvement of Qmax and PVR. PSA decreased from 7.9 ng/ ml to 1.75 ng/ml, serum creatinine from 2.08 mg/dl to 1.46 mg/dl. QoL questionnaire measured an increased Quality of Life after each surgery. IPSS and OAB-qSF questionnaires confirmed the resolution of LUTS. Conclusion: Despite the patient's age, comorbidity and multiple severe urological pathologies, surgical treatments showed safety and effectiveness, improving patient quality of life.

Keywords:

Elderly; Frailty; LUTS; Benign prostate enlargement; Bladder calculi

Cite the Article:

Graziani D, Suraci PP, Fuschi A, Pastore AL, Al Salhi Y, Scalzo S, et al. Multiple Severe Nonmalignant Urological Pathologies Management in Frail Elderly Patient: A Case Report. Ann Clin Case Rep. 2024; 9: 2686..