Fatal obstructive uropathy secondary to neglected benign prostatic hyperplasia: A medico-legal case report

RATIONALE: Benign prostatic hyperplasia (BPH) is a common, typically nonlethal condition in middle-aged and older men. However, its complications can lead to fatal outcomes if untreated. This report presents a rare fatal case of obstructive uropathy and renal failure resulting from neglected BPH. PATIENT CONCERNS: A 54-year-old reclusive male with no known medical interventions was found deceased at home after being unresponsive to contact for several days. DIAGNOSES: Postmortem examination revealed marked bladder distension (2500 mL), hemorrhagic cystitis, prostatic enlargement (45 g) with urethral obstruction, bilateral hydronephrosis, and renal cortical cysts. Histopathology confirmed obstructive nephropathy and renal failure. Extreme elevations in postmortem serum creatinine (879 μmol/L) and urea (153.4 mmol/L) supported the diagnosis of terminal uremia. Toxicological screening was negative. INTERVENTIONS: No medical interventions were undertaken prior to death. OUTCOMES: The patient died due to complications of BPH, specifically urinary retention leading to obstructive nephropathy, renal failure (uremia), and subsequent multi-organ dysfunction syndrome. LESSONS: This case underscores the potentially lethal consequences of untreated bladder outlet obstruction from BPH. It highlights the importance of clinical vigilance, early intervention, and patient education, particularly for at-risk individuals such as those living alone or with limited healthcare access.