Urinary Obstruction Case Study: 57-Year-Old Patient ✓ Solved

Urinary Obstruction Case Studies The 57 Year Old Patient Noted Urinary

Analyze the case of a 57-year-old patient presenting with urinary hesitancy and reduced urinary stream, highlighting clinical findings, diagnostic steps, and management strategies for urinary obstruction caused by benign prostatic hypertrophy (BPH).

Sample Paper For Above instruction

Urinary obstruction is a common urological condition, especially prevalent among middle-aged and older men. The case of a 57-year-old patient exhibiting urinary hesitancy and decreased urinary stream over several months exemplifies typical presentation and diagnostic evaluation of benign prostatic hypertrophy (BPH) causing outlet obstruction.

Clinical Presentation and Initial Evaluation

The patient’s symptoms of hesitancy and decreased stream suggest bladder outlet obstruction, often caused by prostate enlargement in older men. Physical examination revealed an enlarged, soft, and bulky prostate, consistent with BPH. The absence of other neurological or systemic abnormalities pointed toward prostatic pathology as the primary cause.

Diagnostic Studies and Findings

Routine laboratory tests were within normal limits, ruling out infection or other systemic issues. Imaging studies like intravenous pyelogram (IVP) demonstrated mild indentation of the bladder interior, indicating external compression likely due to prostate expansion. Uroflowmetry revealed significantly decreased flow rate (12 mL/sec), confirming functional obstruction despite adequate bladder volume.

Cystometry showed normal bladder pressures and contractility, with a resting pressure of 35 cm H2O and a peak pressure of 50 cm H2O during voiding, indicating that the bladder musculature was functioning appropriately and that the primary issue was outlet resistance. Cystoscopy confirmed benign prostatic hypertrophy without evidence of malignancy.

Laboratory Markers and Imaging

Prostatic-specific markers, such as prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA), were within normal ranges, supporting a benign process. Transrectal ultrasound confirmed diffuse prostate enlargement without focal lesions or tumors.

Management and Treatment

The patient was diagnosed with bladder outlet obstruction secondary to BPH. Given the findings, transurethral resection of the prostate (TURP) was selected as the definitive treatment. Postoperative course was uneventful, and the patient experienced symptom relief, with improved urinary flow and reduced hesitancy.

Discussion of Critical Thinking Questions

1. Does BPH predispose this patient to cancer?

While BPH itself is a benign condition, its presence may complicate prostate cancer diagnosis, as prostate enlargement can obscure early detection. There is some evidence suggesting that BPH and prostate cancer may share some risk factors but BPH does not directly predispose to malignancy (McVary et al., 2016).

2. Why are patients with BPH at increased risk for urinary tract infections?

Obstruction causes incomplete bladder emptying, leading to urinary stasis, which promotes bacterial growth and increases susceptibility to urinary tract infections (Hennessey et al., 2015).

3. What would you expect the patient’s PSA level to be after surgery?

Post-prostatectomy or surgical management generally reduces PSA levels to near zero; however, in BPH, PSA levels may decrease modestly but typically remain within normal ranges (Koyama et al., 2017).

4. What are the recommended screening guidelines and treatments for BPH?

Screening involves digital rectal exam (DRE), PSA testing, and patient symptom assessment via the International Prostate Symptom Score (IPSS). Treatment options range from watchful waiting, pharmacotherapy (alpha-blockers, 5-alpha reductase inhibitors), to surgical interventions such as TURP or laser surgery, depending on symptom severity (American Urological Association, 2018).

5. What are some alternative treatments/natural homeopathic options for treatment?

Complementary approaches include phytotherapy with saw palmetto, beta-sitosterol, and pumpkin seed extracts, which may alleviate symptoms, although evidence varies (Bent et al., 2017). Lifestyle modifications like reduced caffeine and fluid intake before bedtime can also improve symptoms.

References

• American Urological Association. (2018). Management of benign prostatic hyperplasia (BPH). AUA Guidelines.
• Bent, S., Kane, C., Mckay, D., et al. (2017). Saw palmetto for benign prostatic enlargement. Cochrane Database of Systematic Reviews, 4, CD001423.
• Hennessey, J. V., et al. (2015). Urinary tract infections and prostate obstruction. Urology Journal, 12(3), 1735–1740.
• Koyama, T., et al. (2017). PSA dynamics after prostate surgery. Journal of Urology, 197(3), 731–736.
• McVary, K. T., et al. (2016). The diagnosis and treatment of benign prostatic hyperplasia. Journal of Andrology, 37(1), 10–17.