38 yr old female w/c/o dysuria

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

PATIENT HISTORY: Pt is a 38 yr old female homemaker.

She had no complaints before 2020.

2 yrs ago, she started c/o burning micturition one day with increased urgency and frequency. At first, she ignored it for a few months, but as the burning sensation intensified, she went to Kolkata for consultation. Medication was prescribed, but no improvement was noted. She would go to the washroom 3-4 times every hour and needed 20-25 mins to pass urine.

In the meantime, she started c/o decreased urine output, dysuria, incomplete bladder voiding, and a bloated lower abdomen. She once c/o pain and passing of reddish urine. Went to Hyderabad, where Dr. diagnosed it as urethral stricture and performed a urethrotomy, and medications were prescribed. She was told to do HEGARS dilatation at home 2x daily, but she could not do it for 1 month because of the unavailability of the instrument. Doing it 2x daily for 2 subsequent months improved her urine outflow. But then since the 3rd month, her urine output started decreasing slowly along with dysuria. Feeling demotivated she started doing the dilatation only once daily, which further aggravated her symptoms. On Dr.'s advice, she resumed doing it 2x daily but saw no improvement.

She again went to Hyderabad, where Dr. diagnosed it to be a reoccurrence of urethral stricture. HEGARS dilatation and Foley's catheterization were done. She was told to do HEGARS dilatation at home 2x daily. After returning home, she was doing HEGARS dilatation once daily which improved her urine output and she had no complaints.

At end of Nov, she had stopped doing the dilatation for 15 days since she was told to reduce the freq slowly if improvement is seen. Soon after, she started c/o bloated lower abd, lower abd cramping pain, dysuria and burning micturition. She consulted Dr. who advised her to restart dilation 2x daily. But still, she is doing it only once daily (demotivated since no improvement even on using dilator).

Went to a local Dr. who diagnosed it to be a reoccurrence of urethral stricture and UTI (causative agent -E.coli) and prescribed medications {cyclopam (dicyclomine and paracetamol), nitrofurantoin, pansec dsr (Domperidone and Pantoprazole), alkasol syrup (after taking which for the first time she reported passing white milky urine once)}. Taking medication reduced her lower abdomen pain. She goes to the washroom 8-10 times daily each time taking 25-30 mins for passing urine.

For the past 6 months, on eating a bit of spicy or oily food within 3 hrs c/o gastric problems (abd bloated, sour burps, flatulence), reduced appetite, and constipation ( defaecation once a day, followed by no defaecation at all the next day), and general body weakness.

Pt denied any history of DM/HTN.

Reported food allergy - brinjal, egg, shrimp

Addiction - paan since 15 yrs age (5-6 times daily) with tobacco.

CHIEF COMPLAINTS AND Pt REQ.: since past 15 days c/o burning micturition, dysuria

Gastric problems (abd bloated, sour burps, flatulence), reduced appetite, and constipation for the past 6 months

FAMILY HISTORY: Pt claimed her family members' health to be completely alright.