Giant median lobe enlargement of the prostate mimicking advanced bladder tumour: a case report.

BACKGROUND: Giant Prostate (more than 100 g) is rare worldwide but Common in Africa. However Giant Median Lobe Enlargement is rare even in Africa. This Uncommon entity may pose a diagnostic puzzle especially when associated with haematuria, necroturia and suprapubic mass with background history of childhood haematuria. OBJECTIVE: To present a rare case of a giant benign median lobe enlargement of the prostate. METHODS: A 75 year old retired police officer presenting with 18 months history of intermittent total Painless hematuria, necroturia, increased frequency and feeling of incomplete bladder emptying. There was hesitancy and difficulty in passing Urine improved by manual pressure on the lower abdomen by the patient. Patient was evaluated clinically, radiologically, and also had Urine Cytology suggestive of malignancy. Cystoscopy and Biopsy revealed Inflammation. Patient sought medical Treatment in several hospitals and finally referred to our hospital. RESULTS: He was found to be clinically preserved, not pale, with a mobile suprapubic mass of about 12 cm above pubic symphysis,. Digital Rectal Examination revealed prostate not enlarged. Abdomino-Pelvic ultrasound scan, Intravenous Urography, and Urethrocystography all suggested a huge bladder Tumour at the base occupying almost half of the bladder. Patient was prepared for Cystectomy and Urinary diversion. However, intra-operative finding revealed a giant median lobe enlargement of the prostate (225 g) with normal lateral Lobes, no other bladder mass seen. Transvesical prostatectomy was carried out. Patient did well postoperatively and was discharged. CONCLUSION: Giant Median Lobe Enlargement of the Prostate is rare and may present with hematuria, necroturia and supra pubic mass with normal digital rectal examination.