Cazuri urologie

Caz 1

Adenom de prostata de 80 de grame cu retentie de urina. Infectie de tract urinar. Anemie

secundara. Cardiopatie ischemica.

Analize de laborator:

12.08.13 13:51 : PT (sec)=16.7 sec, INR=1.07 INR, IP(%)=89.6 %, APTT(sec)=30.2 sec, SG=1.015, NIT=neg,

LEU=neg Leu/ul, PH=7, ERY=10 Ery/ul, PRO=neg mg/dl, GLU=norm mg/dl, ASC=neg mg/dl, KET=neg mg/dl,

UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=Prezente hematii, 6-8 leucocite/c, prezente cristale

urat de amoniu, prezente cristale fosfati amoniaco - magnezieni, saruri amorfe, WBC=6.5 *10/L, RBC=4.24

*10^6/L, HGB=11.7 g/dl, HCT=37 %, MCV=87.3 fL, MCH=27.6 pg, MCHC=31.6 g/dl, PLT=235 *10/L,

LYM%=18.3 %, MXD%=8.4 %, NEUT%=73.3 %, LYM*=1.2 *10/L, MXD=0.5 *10/L, NEUT=4.8 *10/L,

RDW=44.5 fl, RDW%=13 %, PDW=10.7 fl, MPV=8.5 fL, P-LCR%=15.4 %, UROCULTURA< 1.000 ufc/ml

(negativ), UREA=44.5 MG/DL, CREATININA SERICA=0.99 MG/DL, GLU=168 MG/DL, REZERVA

ALCALINA=22 mEq/L, FOSFATAZA ALCALINA=128 U/L, TGO=12 U/L, TGP=9 U/L, ACID URIC=3.53

mg/dL, K=3.9 MMOL/L, NA=136 mmol/l

28.08.13 09:26 : WBC=17.8 *10/L, RBC=4.07 *10^6/L, HGB=11.3 g/dl, HCT=35 %, MCV=86 fL,

MCH=27.8 pg, MCHC=32.3 g/dl, PLT=323 *10/L, LYM%=7.3 %, MXD%=8.1 %, NEUT%=84.6 %, LYM=1.3

*10/L, MXD=1.4 *10/L, NEUT=15.1 *10/L, RDW=43.6 fl, RDW%=13 %, PDW=9.1 fl, MPV=7.7 fL, P-

LCR%=10.1 %

Pacientul se interneaza cu diagnosticul de adenom de prostata de cca 70 de grame cu retentie de

urina. Se decide si se practica rezectia transuretrala a prostatei cu rezectia de cca 50 de grame de

tesut prostatic (21 august 2013). Evolutia postoperatorie este favorabila. Se externeaza vindecat,

afebril, cu mictiuni facile, cu urina limpede, cu recomandarile:

tratament cu Uractiv 3x1 cps/zi, 7 zile

tratament cu Tavanic 500 mg, 1 cps/zi, seara, 5 zile

regim hidric 2 l de ceai de cozi de cirese zilnic

repaus fizic 4 saptamani

control peste 1 luna clinic, ecografic si in functie de examenul histopatologic

Caz 2(69 ani)

SCLEROZA DE COL VEZICAL HEMATURIE COAGULOPATIE

TRANSFUZIE DE SINGE

INTERNAT CU DGS DE MAI SUS SE INTERVINE CHIRURGICAL SI SE PRACTICA DECAJOTAREA

VEZICII URINARE, HEMOSTAZA IN 2 REPRIZE EVOLUTIE IN FINAL FAVORABILA EXTERNAT CU

REC DE EPICEF 2X200 MG LA ZI 10 ZILE CENTRUM 1 TB LA ZI 30 ZILE CONTROL LA 10 ZILE

Analize de laborator:

07.08.13 09:32 :

WBC*=7.5 *10/L , RBC*=* 4.39 *10^6/L , HGB*=* 12.8 g/dl , HCT*=* 39.5 %

, MCV*=90 fL , MCH*=29.2 pg , MCHC*=32.4 g/dl , PLT*=185 *10/L ,

LYM%*=23.6 % , MXD%*=*00 % , NEUT%*=*00 % , LYM*=1.8 *10/L ,

MXD*=*00 *10/L , NEUT*=*00 *10/L , RDW*=46.4 fl , RDW%*=13.7 % ,

PDW*=13.4 fl , MPV*=9.9 fL , P-LCR%*=24.7 %

Analize de laborator:

08.08.13 08:05 :

WBC*=5.6 *10/L , RBC*=* 3.85 *10^6/L , HGB*=* 11.3 g/dl , HCT*=* 34.5 %

, MCV*=89.6 fL , MCH*=29.4 pg , MCHC*=32.8 g/dl , PLT*=150 *10/L ,

LYM%*=23 % , MXD%*=* 12.3 % , NEUT%*=64.7 % , LYM*=1.3 *10/L ,

MXD*=* 0.7 *10/L , NEUT*=3.6 *10/L , RDW*=47.1 fl , RDW%*=13.7 % ,

PDW*=13.1 fl , MPV*=9.6 fL , P-LCR%*=23.7 %

Analize de laborator:

09.08.13 09:29 :

WBC*=5.6 *10/L , RBC*=* 3.85 *10^6/L , HGB*=* 11.2 g/dl , HCT*=* 34.6 %

, MCV*=89.9 fL , MCH*=29.1 pg , MCHC*=32.4 g/dl , PLT*=173 *10/L ,

LYM%*=28.1 % , MXD%*=* 10.1 % , NEUT%*=61.8 % , LYM*=1.6 *10/L ,

MXD*=0.6 *10/L , NEUT*=3.4 *10/L , RDW*=45.9 fl , RDW%*=13.6 % ,

PDW*=13 fl , MPV*=9.8 fL , P-LCR%*=24.4 %

Analize de laborator:

11.08.13 10:10 :

PT *(sec)=* 19.1 sec , INR*=1.24 INR , IP* (%)=* 75.1 % , WBC*=7.1 *10/L ,

RBC*=* 3.20 *10^6/L , HGB*=* 9.2 g/dl , HCT*=* 29.5 % , MCV*=92.2 fL ,

MCH*=28.8 pg , MCHC*=* 31.2 g/dl , PLT*=164 *10/L , LYM%*=* 13 % ,

MXD%*=*00 % , NEUT%*=*00 % , LYM*=* 0.9 *10/L , MXD*=*00 *10/L ,

NEUT*=*00 *10/L , RDW*=46.5 fl , RDW%*=13.7 % , PDW*=13.6 fl ,

MPV*=10.4 fL , P-LCR%*=28.5 %

Analize de laborator:

12.08.13 10:28 :

WBC*=5.5 *10/L , RBC*=* 3.01 *10^6/L , HGB*=* 8.6 g/dl , HCT*=* 27.7 % ,

MCV*=92 fL , MCH*=28.6 pg , MCHC*=* 31 g/dl , PLT*=158 *10/L , LYM%*=*

13.2 % , MXD%*=*00 % , NEUT%*=*00 % , LYM*=* 0.7 *10/L , MXD*=*00

*10/L , NEUT*=*00 *10/L , RDW*=46.8 fl , RDW%*=13.7 % , PDW*=* 11.8 fl

, MPV*=9.4 fL , P-LCR%*=21 %

Analize de laborator:

14.08.13 06:39 :

PT *(sec)=* 22.2 sec , INR*=1.45 INR , IP* (%)=* 61.6 % , WBC*=5.1 *10/L ,

RBC*=* 3.03 *10^6/L , HGB*=* 8.7 g/dl , HCT*=* 27.8 % , MCV*=91.7 fL ,

MCH*=28.7 pg , MCHC*=* 31.3 g/dl , PLT*=168 *10/L , LYM%*=27.3 % ,

MXD%*=8.1 % , NEUT%*=64.6 % , LYM*=1.4 *10/L , MXD*=0.4 *10/L ,

NEUT*=3.3 *10/L , RDW*=48.4 fl , RDW%*=14.1 % , PDW*=* 11 fl , MPV*=9.5

fL , P-LCR%*=21.8 %

Analize de laborator:

25.07.13 14:24 :

PT *(sec)=17.1 sec , INR*=1.11 INR , IP* (%)=86.1 % , APTT* (sec)=29.7 sec ,

SG*=1.025 , NIT*=pos , LEU*=75 Leu/ul Leu/ul , PH*=5 , ERY*=300 Ery/ul

Ery/ul , PRO*=500 mg/dl mg/dl , GLU*=norm mg/dl , ASC*=neg mg/dl , KET*=neg

mg/dl , UBG*=norm mg/dl , BIL*=neg mg/dl , EX. URINA -

SEDIMENT*=HEMATURIE MICRO SI MACROSCOPICA , WBC*=8.3 *10/L ,

RBC*=* 4.32 *10^6/L , HGB*=* 12.6 g/dl , HCT*=* 39.1 % , MCV*=90.5 fL ,

MCH*=29.2 pg , MCHC*=32.2 g/dl , PLT*=188 *10/L , LYM%*=* 18.7 % ,

MXD%*=8.9 % , NEUT%*=72.4 % , LYM*=1.6 *10/L , MXD*=* 0.7 *10/L ,

NEUT*=6 *10/L , RDW*=46.3 fl , RDW%*=13.3 % , PDW*=13.4 fl , MPV*=9.8

fL , P-LCR%*=25 % , UROCULTURA=< 1.000 ufc/ml (negativ) ,

UROCULTURA_ANTIBIOGRAMA= , UREA*=39 MG/DL , CREATININA

SERICA*=* 1.32 MG/DL , GLUC*=* 108 MG/DL

Analize de laborator:

31.07.13 08:05 :

PT *(sec)=18.7 sec , INR*=1.21 INR , IP* (%)=* 77.2 % , APTT* (sec)=30.3 sec ,

WBC=6.43 10*3/uL , BAS#=0.01 10*3/uL , BAS%=0.2 % , NEU#=4.70 10*3/uL ,

NEU%=73.2 % , EOS#=0.23 10*3/uL , EOS%=3.5 % , LYM#=* 1.09 10*3/uL ,

LYM%=* 16.9 % , MON#=0.40 10*3/uL , MON%=6.2 % , ALY#=0.04 10*3/uL ,

ALY%=0.6 % , LIC#=* 0.40 10*3/uL , LIC%=* 6.2 % , RBC=* 3.52 10*6/uL ,

HGB=* 10.8 g/dL , MCV=92.2 fL , MCH=30.7 pg , MCHC=33.2 g/dL , RDW-

CV=12.9 % , RDW-SD=46.5 fL , HCT=* 32.5 % , PLT=* 137 10*3/uL , MPV=8.7 fL

, PDW=* 16.7 , PCT=0.119 %

Caz 3(56 ani)

Litiaza ureterala pelvina dreapta. Colica renala dreapta. Ureterohidronefroza dreapta.

Analize de laborator:

13.08.13 05:48 : SG=1.025, NIT=neg, LEU=25 Leu/ul, PH=6, ERY=50 Ery/ul, PRO=neg mg/dl,

GLU=norm mg/dl, ASC=neg mg/dl, KET=neg mg/dl, UBG=2 mg/dl, BIL=neg mg/dl, EX. URINA -

SEDIMENT=Frecvente hematii, prezente leucocite, abundent mucus, WBC=10.4 *10/L, RBC=4.92

*10^6/L, HGB=14.4 g/dl, HCT=44.3 %, MCV=90 fL, MCH=29.3 pg, MCHC=32.5 g/dl, PLT=273

*10/L, LYM%=21.6 %, MXD%=10 %, NEUT%=68.4 %, LYM=2.2 *10/L, MXD=1 *10/L,

NEUT=7.2 *10/L, RDW=45.4 fl, RDW%=13.3 %, PDW=11.2 fl, MPV=9.3 fL, P-LCR%=19.2 %,

UREA=40.2 MG/DL, AMYL=70 U/L, T-BIL=0.73 MG/DL, D-BIL=0.33 MG/DL, CREATININA

SERICA=1.27 MG/DL, GLUC=123 MG/DL, TGO=54 U/L, TGP=84 U/L

13.08.13 13:56 : PT (sec)=17.8 sec, INR=1.15 INR, IP(%)=82.4 %, APTT(sec)=25.6 sec

19.08.13 17:07 : Helicobacter Pylori=NEGATIV, SG=1.025, NIT=neg, LEU=neg Leu/ul, PH=5,

ERY=neg Ery/ul, PRO=neg mg/dl, GLU=norm mg/dl, ASC=20 mg/dl, KET=neg mg/dl, UBG=norm

mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=5 - 6 leucocite /c, mucus, rare epitelii plate

Pacientul se interneaza de urgenta pentru colica renala dreapta. Se decide si se instituie tratament

antialgic, antibiotic si de expulzie litiazica cu evolutie favorabila. Se externeaza ameliorat,

afebril, cu urina limpede, cu recomandarile:

tratament cu Uricol 3x1 plicuri/zi, 7 zile

tratament cu Tador 25 mg, 3x1 cps/zi, 3 zile, dupa masa

regim hidric normal control peste 2 saptamani

Caz 4(62 ani)

Adenom de prostata de 90 de grame cu simptomatologie obstructiva severa si retentie cronica de

urina.. Diabet zaharat tip 2 sub insulinoterapie. Anemie secundara. Hipertensiune arteriala

esentiala. Cardiopatie ischemica. Infectei de tract urianr cu E. Coli.

Analize de laborator:

12.08.13 12:03 : PT(sec)=15.6 sec, INR=1.00 INR, IP(%)=98.1 %, APTT(sec)= 20.2 sec, SG=1.020, NIT=pos,

LEU=500 Leu/ul, PH=5, ERY=10 Ery/ul, PRO=neg mg/dl, GLU=norm mg/dl, ASC=neg mg/dl, KET=neg mg/dl,

UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=frecvente leucocite izolate si in gramezi, frecventa

flora microbiana, 8-10 hematii/camp, WBC=6.8 *10/L, RBC=4.63 *10^6/L, HGB=14.3 g/dl, HCT=43.9 %,

MCV=94.8 fL, MCH=30.9 pg, MCHC=32.6 g/dl, PLT=129 *10/L, LYM%=40.9 %, MXD%=12.5 %,

NEUT%=46.6 %, LYM=2.8 *10/L, MXD= 0.9 *10/L, NEUT=3.1 *10/L, RDW=47.8 fl, RDW%=13.4 %,

PDW=13.6 fl, MPV=10.5 fL, P-LCR%=30 %, UROCULTURA=E.COLI > 100.000 UFC/ML,

UROCULTURA_ANTIBIOGRAMA=SENSIBIL=CEFUROXIME,NEGRAMREZISTENT=AMOXICILINA,PEF

LOXACIN,CIPROFLOXACIN,BISEPTOL,NORFLOXACIN,AMPICILINA, UREA=41.8 MG/DL,

CREATININA SERICA=1.14 MG/DL, GLUC=97 MG/DL, REZERVA ALCALINA=22 mEq/L, FOSFATAZA

ALCALINA=103 U/L, TGO=23 U/L, TGP=8 U/L, ACID URIC=5.16 mg/dL, K=4.7 MMOL/L, NA=149 mmol/l

17.08.13 06:11 : WBC=9.0 *10/L, RBC=4.44 *10^6/L, HGB=13.8 g/dl, HCT=41.2 %, MCV=92.8 fL,

MCH=31.1 pg, MCHC=33.5 g/dl, PLT=115 *10/L, LYM%=21.7 %, LYM=2 *10/L, GLUC=75 MG/DL

Pacientul se interneaza cu diagnosticul de adenom de prostata de cca 90 de grame cu lob median

proeminent (40 de grame) cu simptomatologie urinara joasa mixta severa cu obstructie subvezicala si

retentie cronica de urina. Se decide si se practica rezectei transuretrala a lobului median si partial a lobilor

laterali (16.08.2013). Evolutia postoperatorie este favorabila. Se externeaza ameliorat, afebril, cu urina

limpede, mictiuni facile, cu urina limpede, cu recomandarile:

tratament cu Avodart 0,5 mg, 1 cps/zi, dimineata 1 luna

tratament cu Zinnat 500 mg, 2x1 cps/zi, 5 zile

repaus fizic 4 saptamani

regim hidric 2 l de ceai de cozi de cirese zilnic 7 zile

continua tratamentul cardiologic si diabetologic

control peste 1 luna clinic si urodinamic

Caz 5 (Nenea Tofeni Dumitru-62 ani)

Adenocarcinom prostatic extracapsular cu retentie de urina. Infectie de tract urinar cu Stafilococ.

Anemie secundara.

Analize de laborator:

12.08.13 12:00 : PT (sec)=18.3 sec, INR=1.18 INR, IP(%)=79.5 %, APTT(sec)=24.8 sec, SG=1.015,

NIT=pos, LEU=75 Leu/ul, PH=6, ERY=300 Ery/ul, PRO=500 mg/dl, GLU=norm mg/dl, ASC=neg

mg/dl, KET=neg mg/dl, UBG=2 mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=frecvente leucocite,

hematii si flora microbiana, WBC=7.7 *10/L, RBC=5.10 *10^6/L, HGB=12.2 g/dl, HCT=40.1 %,

MCV=78.6 fL, MCH=23.9 pg, MCHC=30.4 g/dl, PLT=207 *10/L, LYM%=22.2 %, MXD%=7.6 %,

NEUT%=70.2 %, LYM=1.7 *10/L, MXD=0.6 *10/L, NEUT=5.4 *10/L, RDW=47.1 fl,

RDW%=16.1 %, PDW=11.7 fl, MPV=9.5 fL, P-LCR%=22.6 %,

UROCULTURA=STAFILOCOC ALB > 100.000 UFC/ML, UROCULTURA

ANTIBIOGRAMA=SENSIBIL=CEFUROXIME, BISEPTOL

REZISTENT=AMPICILINA,AMOXICILINA,PEFLOXACIN,CIPROFLOXACIN, NEGRAM,

NORFLOXACIN, UREA=24 MG/DL, CREATININA SERICA=0.93 MG/DL, GLUC=74 MG/DL,

REZERVA ALCALINA=23 mEq/L, FOSFATAZA ALCALINA=107 U/L, TGO=18 U/L, TGP=9 U/L,

ACID URIC=4.42 mg/dL, K=4.3 MMOL/L, NA=138 mmol/l 14.08.13 07:02 : PSA=90,30 ng/mL

Pacientul se interneaza cu diagnosticul de adenom de prostata cu retentie de urina. Se evalueaza

clinic si paraclinic si se precizeaza diagnosticul clinic de adenocarcinom prostatic extracapsular

T3aNxMx. Se decide si se practica rezectia bioptica si de deblocare a prostatei (20.08.2013).

Evolutia postoperatorie este favorabila. Se externeaza ameliorat, afebril, cu urina limpede, cu

cateter uretro-vezical 18 Ch permeabil, cu recomandarile:

tratament cu Biseptol 2x2 cps/zi, 7 zile

tratament cu Uractiv 3x1 cps/zi, 7 zile

regim hidric 2 litri de ceai de cozi de cirese zilnic

consult oncologic luni 02 septembrie 2013 ora 08:30 (dr. Bindea)

revine marti 17 septembrie 2013 pentru suprimarea cateterului uretro-vezical

Caz 6 (72 ani)

Adenocarcinom prostatic T3aN0M0. Cardiopatie ischemica cronica.

Analize de laborator:

20.08.13 09:01 : PT(sec)=14.8 sec, INR=0.94 INR, IP(%)=105.1 %, APTT(sec)=31.3 sec, SG=1.025,

NIT=neg, LEU=neg Leu/ul, PH=5, ERY=neg Ery/ul, PRO=neg mg/dl, GLU=norm mg/dl, ASC=20

mg/dl, KET=neg mg/dl, UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=rare leucocite

,frecvente cristale ac.uric WBC=6.70 10*3/uL, BAS=0.02 10*3/uL , BAS%=0.4 %, NEU=4.68 10*3/uL,

NEU%=69.8 %, EOS=0.25 10*3/uL, EOS%=3.8 %, LYM=1.33 10*3/uL, LYM%=19.8 %, MON=0.42

10*3/uL, MON%=6.2 %, ALY=0.00 10*3/uL, RBC=4.25 10*6/uL, HGB=13.1 g/dL, MCV=92.5 fL ,

MCH=30.8 pg, MCHC=33.3 g/dL, RDW-CV=13.6 %, RDW-SD=53.0 fL, HCT=39.3 %, PLT=200

10*3/uL, MPV=8.9 fL, PDW=15.9, PCT=0.178 %, UROCULTURA< 1.000 ufc/ml (negativ), UREA=42

MG/DL, CREATININA SERICA=1.11 MG/DL, GLUC=80 MG/DL

21.08.13 06:52 : PSA=13,13 ng/mL

Pacientul se interneaza pentru suspiciune clinica si biochimica de adenocarcinom prostatic

(PSA=13 ng/ml). Se decide si se practica punctia bioptica a prostatei (23.08.2013). Evolutia

postprocedura este favorabila. Se externeaza ameliorat, afebril, cu urina limpede, cu

recomandarile:

tratament cu Ofloxacin 200 mg, 2x1 cps/zi, 7 zile

tratament cu Nitromint 2,6 1-0-1 , 7 zile revine peste 4 saptamani pentru evaluare in functie de examenul histopatologic

Caz 7 (57 ani)

Litiaza ureterala stanga migranta. Ureterohidronefroza stanga.

Analize de laborator:

20.08.13 11:23 : PT(sec)=15.6 sec, INR=1.00 INR, IP(%)=98.1 %, APTT(sec)=30.9 sec,

SG=1.010, NIT=neg, LEU=neg Leu/ul, PH=8, ERY=neg Ery/ul, PRO=neg mg/dl, GLU=norm

mg/dl, ASC=neg mg/dl, KET=neg mg/dl, UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA -

SEDIMENT=10-15 leucocite/camp,prezente epitelii plate,rare hematii,rare cristale oxalat de

calciu, WBC=6.23 10*3/uL, BAS=0.02 10*3/uL, BAS%=0.3 %, NEU=4.76 10*3/uL,

NEU%=76.5 %, EOS=0.06 10*3/uL, EOS%=1.0 %, LYM=1.03 10*3/uL, LYM%=16.5 %,

MON=0.36 10*3/uL, MON%=5.7 %, ALY=0.01 10*3/uL, ALY%=0.1 %, RBC=4.80 10*6/uL,

HGB=13.1 g/dL, MCV=82.9 fL, MCH=27.3 pg, MCHC=32.9 g/dL, RDW-CV=13.6 %, RDW-

SD=47.0 fL, HCT=39.8 %, PLT=275 10*3/uL, MPV=8.5 fL, PDW=16.0, PCT=0.234 %,

UROCULTURA< 1.000 ufc/ml (negativ), UREA=41.5 MG/DL, CREATININA SERICA=1.99

MG/DL, GLUC=84 MG/DL

Pacientul se interneaza de urgenta pentru colica renala stanga. Se evalueaza clinic si paraclinic si

se evidentiaza diagnosticul de litiaza ureterala stanga radio-transparenta cu ureterohidronefroza

de gradul 1. Se instituie tratament antialigic, litolitic si de expulzie litiazica cu evolutie

favorabila. Se externeaza ameliorat, afebril, cu urina limpede, cu recomandarile:

tratament cu Uractiv 3x1 cps/zi, 7 zile

tratament cu Tador 25 mg, 3x1 cps/zi, 3 zile, dupa-masa

regim hidric normal control peste 2 saptamani

Caz 8 (74 ani)

Strictura de uretra bulbara proximala. Infectie de tract urinar. Adenom de prostata. Cistita

cronica. Accident vascular sechelar. Anemie secundara.

Analize de laborator:

26.08.13 11:42 : PT(sec)=17.0 sec, INR=1.09 INR, IP (%)=87.6 %, APTT (sec)=27.6 sec, SG=1.010,

NIT=pos, LEU=500 Leu/ul, PH=7, ERY=50 Ery/ul, PRO=500 mg/dl, GLU=norm mg/dl, ASC=neg

mg/dl, KET=neg mg/dl, UBG=norm mg/dl, BIL=1 mg/dl, EX. URINA - SEDIMENT=frecvente

leucocite, hematii si flora microbiana, cristale fosfat amoniaco magnezian , WBC=6.9 *10/L,

RBC=4.71 *10^6/L, HGB=13.2 g/dl, HCT=41.8 %, MCV=88.7 fL, MCH=28 pg, MCHC=31.6 g/dl ,

PLT=354 *10/L, LYM%=33.3 %, MXD%=5 %, NEUT%=61.7 %, LYM=2.3 *10/L, MXD=0.3

*10/L, NEUT=4.3 *10/L, RDW=45.8 fl, RDW%=13.5 %, PDW=10.9 fl, MPV=8.8 fL, P-

LCR%=16.3 %, UROCULTURA=E.COLI > 100.000 UFC/ml, UROCULTURA ANTIBIOGRAMA=S=

PEFLOXACIN, BISEPTOL, NORFLOXACIN, CIPROFLOXACIN R= AMPICILINA,

AMOXICILINA, NEGRAM, CEFUROXIME, UREA=38.1 MG/DL, CREATININA SERICA=0.86

MG/DL, GLUC=129 MG/DL, TGO=16 U/L, TGP=10 U/L

Pacient cunoscut cu cistostomie a-demeure, se interneaza pentru cura stricturii uretrale post-

traumatice. Se decide si se practica uretrotomie optica interna cu montare de cateter uretro-

vezical de 16 Ch (28.08.2013). Evolutia postoperatorie este favorabila. Se externeaza ameliorat,

afebril, cu urina limpede, cu recomandarile:

tratament cu Nolicin 400 mg, 2x1 cps/zi, 7 zile

tratament cu Uractiv 3x1 cps/zi, 7 zile

regim hidric 2 l de ceai de cozi de cirese zilnic 7 zilnic

schimbarea cateterului uretro-vezical peste 3 saptamani

ingrijiri medicale la domiciliu

Caz 9(78 ani)

Prolaps uretral. Cistita cronica. Obezitate. Anemie secundara.

Analize de laborator:

26.08.13 10:43 : PT (sec)=13.6 sec, INR=0.86 INR, IP (%)=117.5 %, APTT(sec)=26.4 sec,

SG=1.025, NIT=neg , LEU=75 Leu/ul, PH=5, ERY=neg Ery/ul , PRO=neg mg/dl, GLU=norm

mg/dl, ASC=neg mg/dl, KET=neg mg/dl, UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA -

SEDIMENT=frecvente leucocite, rare hematii si flora microbiana,mucus, WBC=5.5 10/L ,

RBC=4.33 *10^6/L , HGB=12.8 g/dl, HCT=39.7 %, MCV=91.7 fL, MCH=29.6 pg ,

MCHC=32.2 g/dl, PLT=205 *10/L, LYM%=29.2 %, MXD%=00 %, NEUT%=00 %,

LYM=1.6 *10/L, RDW=46.6 fl, RDW%=13.3 % , PDW= 11.8 fl , MPV=9.1 fL , P-

LCR%=20.2 % , UROCULTURA< 1.000 ufc/ml (negativ), UREA=40.3 MG/DL,

CREATININA SERICA=0.95 MG/DL, GLUC=91 MG/DL, TGO=25 U/L, TGP=25 U/L

Pacienta se interneaza pentru usturimi mictionale. Se evalueaza clinic si se precizeaza

diagnosticul de prolaps uretral. Se decide si se practica excizia prolapsului uretral (23.08.2013).

Evolutia postoperatorie este favorabila. Se externeaza vindecata, afebrila, cu urina limpede, cu

recomandarile:

tratament cu Ofloxacin 200 mg, 2x1 cps/zi, 7 zile

tratament cu Urisan 2x1 cps/zi, 7 zile

tratament cu Tador 25 mg, 3x1 cps/zi, 5 zile

regim hidric normal

control peste 2 saptamani

Caz 10 (29 ani)

Fimoza inflamatorie stransa. Lichen sclerosus.

Analize de laborator:

13.08.13 09:53 : PT(sec)=17.2 sec, INR=1.11 INR, IP(%)=86.2 %, APTT (sec)=27.8 sec, SG=1.025,

NIT=neg, LEU=neg Leu/ul, PH=5, ERY=neg Ery/ul, PRO=neg mg/dl, GLU=norm mg/dl, ASC=neg

mg/dl, KET=neg mg/dl, UBG=norm mg/dl, BIL=neg mg/dl, EX. URINA - SEDIMENT=6-8

leucocite/camp,mult mucus, rare epitelii, WBC=4.5 *10/L, RBC=5.35 *10^6/L, HGB=15.9 g/dl,

HCT=48.3 %, MCV=90.3 fL, MCH=29.7 pg, MCHC=32.9 g/dl, PLT=223 *10/L, LYM%=39.9 %,

LYM=1.8 *10/L, RDW=44.7 fl, RDW%=12.8 %, PDW=15.5 fl, MPV=11.1 fL, P-LCR%=33.3 %,

UROCULTURA< 1.000 ufc/ml (negativ), UREA=32.9 MG/DL, CREATININA SERICA=1.27 MG/DL,

GLUC=79 MG/DL, REZERVA ALCALINA=22 mEq/L, FOSFATAZA ALCALINA=134 U/L, TGO=25

U/L, TGP=17 U/L, ACID URIC=5.82 mg/dL , K=4.6 MMOL/L, NA=140 mmol/l

Pacientul se interneaza pentru fimoza stransa prin lichen sclerosus. Se decide si se practica

circumcizia cu excizia tegumentului afectat (14.08.2013). Evolutia postoperatorie este

favorabila. Se externeaza ameliorat, afebril, cu urina limpede, cu recomandarile:

tratament cu Ofloxacin 200 mg, 2x1 cps/zi, 5 zile

pansament zilnic cu unguent cu Betadina 7 zile

repaus fizic 5 zile

concediu medical la externare 2 zile control peste 2 saptamani

Caz 11(59 ani)

TUMORA SCROTALA DRT(EPIDIDIMARA, TESTICULARA)

INTERNAT CU DGS DE MAI SUS CU REC DE MARKERI TUMORALI SI EX CT PRIN AMBULATORUL

DE SPECIALITATE SE EXTERNEAZA

Analize de laborator:

18.08.13 12:41 :

SG*=1.025 , NIT*=pos , LEU*=500 Leu/ul Leu/ul , PH*=5 , ERY*=300 Ery/ul

Ery/ul , PRO*=500 mg/dl mg/dl , GLU*=norm mg/dl , ASC*=20 mg/dl mg/dl ,

KET*=neg mg/dl , UBG*=norm mg/dl , BIL*=neg mg/dl , EX. URINA -

SEDIMENT*=Camp plin de leucocite si hematii, frecventa flora microbiana , WBC*=* 12.8

*10/L , RBC*=* 4.26 *10^6/L , HGB*=* 12 g/dl , HCT*=* 37.4 % , MCV*=87.8

fL , MCH*=28.2 pg , MCHC*=32.1 g/dl , PLT*=400 *10/L , LYM%*=21.3 % ,

MXD%*=9.3 % , NEUT%*=69.4 % , LYM*=2.7 *10/L , MXD*=* 1.2 *10/L ,

NEUT*=* 8.9 *10/L , RDW*=44.3 fl , RDW%*=12.7 % , PDW*=* 8.8 fl ,

MPV*=7.6 fL , P-LCR%*=9.1 % , UREA*=38.8 MG/DL , T-BIL*=0.47 MG/DL ,

CREATININA SERICA*=0.96 MG/DL , GLUC*=* 115 MG/DL , TGO*=10 U/L ,

TGP*=9 U/L , K=4.5 MMOL/L , NA=136 mmol/l

Analize de laborator:

18.08.13 13:07 :

PT *(sec)=16.9 sec , INR*=1.09 INR , IP* (%)=88.2 % , APTT* (sec)=29.6 sec ,

UROCULTURA=E. COLI > 100.000 UFC / ML

Caz 12(59 ani)

TUMORA SCROTALA DRT (TESTICULARA)CONTUZIE SCROTALA

HERNIE INGHINALA STG

INTERNAT CU O CONTUZIE SCROTALA DRT PROBABIL PE O PATOLOGIE SCROTALA

PREEXISTENTA. RE EFECTUAREA CT PELVIS CU SUBSTANTA DE CONTRAST, MARKERI TUMORALI

Analize de laborator:

15.08.13 19:42 :

PT *(sec)=14.7 sec , INR*=0.94 INR , IP* (%)=* 106.1 % , APTT* (sec)=28.5 sec ,

SG*=1.025 , NIT*=neg , LEU*=25Leu/ul Leu/ul , PH*=6 , ERY*=neg Ery/ul ,

PRO*=neg mg/dl , GLU*=norm mg/dl , ASC*=neg mg/dl , KET*=150 mg/dl mg/dl ,

UBG*=4 mg/dl mg/dl , BIL*=neg mg/dl , EX. URINA - SEDIMENT*=prezente leucocite

izolate si in gramezi,,rare hematii,mucus , WBC*=* 13.7 *10/L , RBC*=* 4.37

*10^6/L , HGB*=15 g/dl , HCT*=43.7 % , MCV*=100 fL , MCH*=* 34.3 pg ,

MCHC*=34.3 g/dl , PLT*=316 *10/L , LYM%*=* 14.5 % , MXD%*=5.8 % ,

NEUT%*=* 79.7 % , LYM*=2 *10/L , MXD*=* 0.8 *10/L , NEUT*=* 10.9

*10/L , RDW*=48.6 fl , RDW%*=12.6 % , PDW*=* 8.7 fl , MPV*=8.1 fL , P-

LCR%*=12.4 % , UREA*=15.8 MG/DL , CREATININA SERICA*=0.91 MG/DL ,

GLUC*=104 MG/DL , REZERVA ALCALINA=20 mEq/L , FOSFATAZA

ALCALINA*=199 U/L , TGO*=27 U/L , TGP*=23 U/L , ACID URIC*=5.65 mg/dL ,

K=3.9 mmol/l , NA=142 mmol/l

Caz 13 (40 ani)

CISTITA HEMORAGICA E COLI SPONDILOPATIE

INTERNATA CU DGS DE MAI SUS , PENTRU O HEMATURIE MACROSCOPICA FARA MODIFICARI LA

EX ECHOGRAFIC, FARA SEMNE DE UROPATIE OBSTRUCTIVA LA EX CT +UIV

REC TRATAMENT CU CIROBAY 2X500 MG LA ZI 10 ZILE APOI CISTYSTAT 1 INSTILATIE

INTRAVEZICAL 4 SAPTAMINI SAPTAMINAL APOI LUNAR INCA 5 INSTILATII, CONTROL UROLOGIC

Analize de laborator:

15.08.13 22:26 :

SG*=1.005 , NIT*=neg , LEU*=500 Leu/ul Leu/ul , PH*=6 , ERY*=50 Ery/ul

Ery/ul , PRO*=500 mg/dl mg/dl , GLU*=norm mg/dl , ASC*=neg mg/dl , KET*=neg

mg/dl , UBG*=norm mg/dl , BIL*=neg mg/dl , EX. URINA - SEDIMENT*=cimp plin

cu leucocite si flora microbiana , prezente hematii , WBC*=* 12.3 *10/L , RBC*=4.34

*10^6/L , HGB*=12.7 g/dl , HCT*=38.9 % , MCV*=89.6 fL , MCH*=29.3 pg ,

MCHC*=32.6 g/dl , PLT*=248 *10/L , LYM%*=* 14.2 % , MXD%*=*00 % ,

NEUT%*=*00 % , LYM*=1.7 *10/L , MXD*=*00 *10/L , NEUT*=*00 *10/L

, RDW*=44.6 fl , RDW%*=13.1 % , PDW*=* 10.2 fl , MPV*=8.5 fL , P-

LCR%*=15.6 % , UREA*=34 MG/DL , AMYL*=50 U/L , CREATININA SERICA*=*

1.19 MG/DL , GLUC*=97 MG/DL , TGO*=22 U/L , TGP*=17 U/L

Analize de laborator:

16.08.13 00:36 :

PT *(sec)=16.1 sec , INR*=1.03 INR , IP* (%)=94.1 % , APTT* (sec)=27.4 sec ,

UROCULTURA=E.COLI > 100.000 UFC/ML ,

UROCULTURA_ANTIBIOGRAMA=SENSIBIL = CIPROFLOXACIN , BISEPTOL ,

PEFLOXACIN , NORFLOXACIN , CEFUROXIME REZISTENT = NEGRAM ,

AMPICILINA , AMOXICILINA