Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature.

Omar Riyach,Mohammed Fadl Tazi,Soufiane Mellas,Youssef Kharbach,Abdelhak Khallouk,Jalal Eddine El Ammari,Mohammed El Jamal Fassi,Mustapha Ahsaini,Mohammed Bounoual,Moulay Hassan Farih

doi:10.1186/1752-1947-8-42

Abstract

IntroductionProstatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature.Case presentationWe report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure.ConclusionThis is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.

Highlights

Prostatic hyperplasia is the most frequent tumor in men older than 50 years of age
Benign prostatic hyperplasia (BPH) is the growth of epithelial, muscular and/or fibrotic cells in the prostate [1] and is responsible for the occurrence of urinary symptoms in men older than 50 years of age. It is clinically manifested by a low obstructive uropathy syndrome, which includes storage and voiding symptoms, and is diagnosed on the basis of an adequate digital rectal examination (DRE), prostate and bladder ultrasound and prostate-specific antigen (PSA) level
* Correspondence: riyach2@hotmail.com †Equal contributors 1Department of Urology, University Hospital Center Hassan II, Fez, Morocco 2Faculty of Medicine and Pharmacy, Fez, BP: 1893 –Km 2.200 Route de Sidi Harazem, Fez, Morocco (IVU) is a radiological tool for the assessment of BPHrelated changes of the upper and lower urinary tracts and other urological diseases. It has been abandoned in routine work-up of patients with BPH because of increased radiation risks, costs and little additional diagnostic benefit compared to ultrasonography [4,5]

Summary

Conclusion

The physiological causes that lead to the ureterovesical junction obstruction in BPH are still incompletely known. It is a rare disease; its diagnosis and early treatment are important because of its association with severe obstructive uropathy and chronic renal insufficiency. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions OR and MA are the principal authors and made major contributions to the writing of the manuscript. YK, MB, MFT, JE, SM, MJE, AK and MHF analyzed and interpreted the patient data and reviewed the literature. All authors read and approved the final manuscript

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