Name: Mr. F. A
Age: 79 Years
Date of Case Taking: Feb 12, 2022
Probable Clinical Diagnosis: Acute urine retention secondary to prostatomegaly. (revealed on USG and 3 storage symptoms: frequency, urgency & nocturia)
On February 12, 2022 this 79 year old man was brought to my clinic by his daughter in law at 7pm. He was a known case of diabetes mellitus for the last 30 years. He complained that he was not able to pass urine for the last 2-3 days. He carried with him a USG report ordered by another doctor on the same day which stated that he had prostatomegaly.
His lower abdomen was massively distended and he was finding it difficult to breathe normally. He complained of stinging pain during micturition. He was able to pass only 2-3 drops. He also suffered from fever since the afternoon of the same day.
His problem of frequent urination was aggravated at midnight to 12.30am. He was able to pass urine only on standing, in sitting he was not able to pass urine. He was afraid of drinking water due to no urination. He avoided eating food.
|Lower urinary system
|Since last 2-3 days
Stinging pain during micturition.
Inability to pass urine with fully distended bladder. Passes only 3 drops then stoppage.
Fever since afternoon of the same day
Urination only in standing position.
Evaluation of Symptoms of Acute Totality
- Boger Boenninghausen’s Repertory was used.
- Prostate gland enlarged, swelled p. 429 (Causation) Calc-c, Con, Puls, Sabal, Staph, Sulph
- Urination drop by drop (strangury) p.435 Calc-c, Con, Puls, Staph, Sulph
- Micturition interrupted p. 437 Con, Puls, Sulph, Sabal
- From my knowledge of Materia Medica this modality “Can urinate only when standing” (Con, Sars)
Materia Medica References for Conium
- Allen’s Key notes- Great difficulty in voiding urine; flow intermits; prostatic affections p.93
- Boger’s synoptic key- Urine stops and starts; >standing. Prostatic dribble p. 178
- Vermeulen’s Concordant Materia Medica- Frequent urination at night. Feeling of pressure on the bladder. Much difficulty in voiding. Dribbling in older men. pg360
Other remedies that repertorized out:
- Sabal Serrulata- There has to be constant desire to pass urine at night. Cystitis from prostate enlargement. Sediment in urine. Starting flow of urine is difficult and painful. Paresis of bladder sphincter; incontinence on exertion like lifting & laughing, absent in our case.
- Pulsatilla– Spasmodic pains in bladder after urination. Urine dribbles when emotionally upset. Urging to urinate on lying on back. Interrupted flow. Haematuria after urination, absent in our case.
- Sarsaparilla– Severe smarting at last drop (conclusion) of urine. Tenesmus of bladder. Can pass urine only when standing. Child screams before passing urine; renal colic and painful urination.( Urging to urinate before menses was absent in our patient.)
- Staphysagria– Important for cystitis in young married women. There is pressure upon the bladder, feels it did not empty. Patient urinates in thin stream or drop by drop. Burning in urethra when not urinating, absent in our case.
Note: Sarsaparilla was eliminated because there were no sediments in urine, nor there was smarting at conclusion of urination. Pulsatilla was eliminated since there was no emotional element involved anywhere in the case. Staphysagria was ruled out since there was no burning when not urinating. Sabal serrulata was also not given because this is not a case of paresis of bladder sphincter.
Final Prescription dated 12 February 2022
- Conium Maculatum LM 0/3, 8 drops every hour.
- Here we have an old man with enlarged prostate with not many characteristics hence the LM scale was considered. One hourly repetition was considered because this case is an acute emergency and repetition alone can stimulate the response in this old patient with low susceptibility.
- Later on LM 6 was given (8-3-22).
- He was only on anti-diabetic medications and no other medicines.
Recent Investigations in August 2022
Urine routine: 35-40 pus cells. USG report dated 18/8/22: Grade 2 prostatomegaly. Post void residue 207ml
- This case taught me that catheterization is not the only way out in a case of sudden urine retention. We learn by facing such emergencies with homoeopathy.
- LM potencies helped to not only restore the flow of urine, but also to reduce the size of his prostate by half in less than a month’s time.
- The most recent USG report repeated 6 months later suggests increase in dimensions of prostate gland along with volume. Although symptomatically the patient is doing well, this treatment may not have been curative but palliative in nature.