Intractable haematuria secondary to pedunculated median lobe of the prostate - a diagnostic dilemma.pdf

  • E.A Obiesie
  • AME Nwofor
  • SO Obiesie
  • C. Odo
  • AO Odili
  • CK Oranusi
  • TU Mbaeri
  • ME Chiemaka
  • C Otene
  • D Orakwe
  • C Azie
  • C Eze
  • UV Nwadi
  • FE Menkiti
  • OO Mbonu
Keywords: Intractable, haematuria, pedunculated, solitary, median lobe, emergency prostatectomy


Benign prostatic hyperplasia is a common disease in the ageing male. Obstructive solitary and pedunculated
intra-vesical enlargement arising from the median lobe of the prostate is rare. The enlarged median lobe, juts into the bladder base, and occasionally occludes the internal urethral opening during voiding (ball valve effect). The clinical diagnosis can be difficult, as digital rectal examination and ultrasonography can be inconclusive. Intractable haematuria associated with benign prostatic obstruction (BPO) is a urological emergency necessitating emergency surgical intervention. We report a 54 year old man, who presented with a 3 year history of worsening severe lower urinary tract symptoms (LUTS) that culminated in
intractable haematuria of 7 days duration and acute urinary retention. Digital rectal examination revealed a flat prostatic fossa with no nodules. PSA was 11.7ng/ml. Ultrasonography revealed a huge prostate with a prominent median lobe (grade-3 IPP) and a post void residual of 176mls. He underwent emergency open transvesical prostatectomy with good surgical outcome.


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