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CASE REPORT
Year : 2003  |  Volume : 19  |  Issue : 2  |  Page : 162
 

Anuria in advanced carcinoma of prostate: Role of methyl prednisolone - a case report


Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Correspondence Address:
P B Singh
Department of Urology, Institute of Medical Sciences, BHU, Varanasi - 221 005
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Anuria, prostatic carcinoma.


How to cite this article:
Malviya V, Kishore G, Hameed A, Dwivedi U S, Singh P B. Anuria in advanced carcinoma of prostate: Role of methyl prednisolone - a case report. Indian J Urol 2003;19:162

How to cite this URL:
Malviya V, Kishore G, Hameed A, Dwivedi U S, Singh P B. Anuria in advanced carcinoma of prostate: Role of methyl prednisolone - a case report. Indian J Urol [serial online] 2003 [cited 2019 Nov 17];19:162. Available from: http://www.indianjurol.com/text.asp?2003/19/2/162/37152



   Case Report Top


An 80-year-old patient with carcinoma of prostate stage D who had bilateral orchidectomy performed 5 years back and was on flutamide presented to us with anuria for 2 days. Prior to it for last 10 days, the patient had gradual decrease in urine output from about 1.5 litres/day to 300 ml/day and became anuric with s.creatinine rising up to 12.2 mg/dl. Before being referred to our department, the patient had received 2 sittings of peritoneal dialysis and his s.creatinine was 6.8 mg/dl and serum potassium 5.5 milieq/L. Ultrasonography revealed bilateral mild hydrone­phrosis. Cystoscopic examination and J-J stenting was at­tempted but it failed, as even guide wire couldn't be negotiated through the ureteric orifices.

Percutaneous nephrostomy (PCN) was planned but pa­tient was not willing for it. Inj. methylprednisolone 500 mg I/V was given over 2 hours for 2 days. After 12 hrs, the patient started pouring urine and in the next 24 hours the urine output of the patient was 3.3 litres. After 2nd dose of I/V methylprednisolone massive diuresis started and the urine output was 11.5 litres and s.creatinine came down to 2.84 mg/dl. From 3rd day oral prednisolone was started in dosages of 5 mg thrice daily. Diuresis continued and s.creatinine settled down by 4th day (s.creatinine 1.6 mg/dl).


   Comments Top


Treatment options in patients with advanced carcinoma of prostate are limited. If internal stenting fails, these pa­tients are subjected to PCN. PCN is not only an invasive procedure but also the quality of life in these patients with advanced carcinoma is poor as maintenance of PCN is difficult. These patients most often have received hormo­nal therapy and because of their limited life span and poor general health, massive surgical correction is not contem­plated. Use of dexamethasone has been described by Hamdy and Williams (1995) [1] to relieve ureteric obstruc­tion and prevent PCN but the response with the drug had come after 2-5 days in their set of evaluated patients. Use of intravenous methylprednisolone relieved ureteric ob­struction within 12 hours. This relief of ureteric obstruc­tion can be because of the anti-inflammatory properties of steroids leading to reduction of oedema (Chye & Lickiss, 1995). [2] The early onset of diuresis prevents the need for dialysis. Due to the early response of intravenous methyl­prednisolone in relieving ureteric obstruction a trial of the drug can be recommended in patients with advanced car­cinoma of prostate that presents with acute renal failure following anuria.

 
   References Top

1.Hamdy FC, Williams JL. Use of dexamethasone for ureteric ob­struction in advanced prostate cancer: percutaneous nephrostomy can be avoided. Br J Urol 1995; 75: 282-285.  Back to cited text no. 1    
2.Chye R, Lickiss N. The use of corticosteroid in the management of bilateral malignant ureteric obstruction. J Pain Symptom Manage 1994; 9(8): 537-40.  Back to cited text no. 2    




 

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