A 19-year-old male presented to our hospital with complaints of severe obstructive urinary symptoms that had been ongoing for several months. He had experienced difficulty initiating urination, a weak urinary stream, and incomplete bladder emptying. In addition, he reported nocturnal enuresis over the past few months, which had become increasingly distressing. The patient had been on catheterization for the past 15 days due to acute obstructive uropathy, which had been managed temporarily by a physician.
Diagnostic Evaluation
Upon arrival, a comprehensive diagnostic workup was initiated. An ultrasound revealed a diffusely thickened and trabeculated bladder wall, consistent with chronic outlet obstruction. The patient had significant post-void residual urine, indicating poor bladder emptying. Further findings included Grade 3 hydroureteronephrosis due to back pressure changes, suggesting prolonged urinary obstruction.
To assess the underlying cause, further specialized investigations were conducted. A MCU scan revealed a left-sided Grade 2 vesicoureteral reflux (VUR), contributing to the patient’s hydronephrosis. The bladder was also poorly compliant, and there was clear evidence of bladder outlet obstruction.
Surgical Management
After thoroughly discussing the diagnostic findings and potential treatment options with the patient and his family, we decided to proceed with surgical intervention to relieve the obstruction and restore normal urinary function.
A cystoscopy was performed, which revealed a tight urethra in the bulbar region. In the same sitting, we performed an Otis urethrotomy to widen the narrowed urethra. Additionally, the cystoscopy showed a high bladder neck, which was contributing to the outlet obstruction. For this, we performed a laser resection of the bladder neck to reduce the obstruction and improve bladder emptying.
The patient tolerated the procedure well, with no intraoperative complications. He was observed overnight and discharged the following day in stable condition, with instructions for follow-up.
Outcome and Follow-Up
The patient’s postoperative recovery was uneventful. Upon follow-up, he reported significant improvement in his urinary symptoms, including resolution of his nocturnal enuresis and a stronger, more consistent urinary stream.
The patient, who had been struggling with urinary symptoms for several months without a clear diagnosis, was finally able to achieve relief after the specialized diagnostic protocols were applied at our center.
Discussion
This case underscores the importance of specialized diagnostic evaluations in patients with complex urological presentations, particularly young patients who may not receive an immediate diagnosis. Obstructive uropathy, combined with nocturnal enuresis and vesicoureteral reflux, can be difficult to manage without targeted diagnostic imaging and investigations, such as ultrasound, UDS, and cystoscopy.
At the Institute of Urology, we emphasize the importance of individualized diagnostic protocols tailored to each patient’s specific needs. Our state-of-the-art diagnostic and surgical infrastructure, sourced from global leaders, allows us to provide the best possible care. In this case, adherence to international protocols and the application of advanced surgical techniques resulted in excellent outcomes for the patient, significantly improving his quality of life.
This case highlights the importance of specialized diagnostic protocols and timely surgical intervention in managing severe obstructive uropathy. The patient’s prolonged symptoms and catheterization were resolved through accurate diagnosis and a combination of Otis urethrotomy and laser bladder neck resection. The Institute of Urology remains committed to providing the highest level of urological care, using cutting-edge technology and protocols to achieve the best outcomes for our patients.
