He sat waiting on the queue along the corridor. He looked dejected and seems to be a widower, I did not confirm this though. Among all the patients visiting the urologic clinic yesterday, he appeared to be the oldest. As I walk in to the consulting room with my colleagues, as students posted to the urologic clinic for the week, I observed it stank of stale urine… the kind that stank from a mile away.

He was called in, by the Medical officer, to see the consultant on call, and he had a very repugnant smell as he took his seat. The exact analogue of a woman with a Vesico Vaginal Fistula (VVF) .

This 63 year old man presented with pain on the left scrotal sac, and it was swollen. Although a know Benign Prostatic Hyperplasia patient, he on him a urinary bag, that required changing every 2 weeks. The catheter in situ, served as a conservative therapy for the diseased prostate. It helps him pass out urine, since the the enlarged prostate prevented the feel flow of urine.

The problem however is that the catheter is already infected since it has been on him for over 3 weeks. He was already showing early symptoms of Urinary tract infections.

The definitive treatment happens to be a prostatectomy, surgically removing the prostate. However he cannot afford the cost of procedure and he obviously has no insurance package. So he has to carry around the urine bag which may leak, as is the case now.

After the consult, the urologist’s plan was to replace the catheter with a new one, and for him to take antibiotics for the infections and some analgesics for the pain. He was scheduled for another visit, in 2 weeks, for a change of the catheter. But this is not the main treatment.

When I asked for the reason for this course of treatment instead of the main thing, the urologist said, ‘The man has no money, Just a Coconut”.


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