Urinary Obstruction Case Study Week 9
Urinary Obstruction Case Study Week 9
The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft.
Studies
Results
Routine laboratory studies
Within normal limits (WNL)
Intravenous pyelogram (IVP)
Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate
Uroflowmetry with total voided flow of 225 mL
8 mL/sec (normal: >12 mL/sec)
Cystometry
Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O)
Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O)
Electromyography of the pelvic sphincter muscle
Normal resting bladder with a positive tonus limb
Cystoscopy
Benign prostatic hypertrophy (BPH)
Prostatic acid phosphatase (PAP)
0.5 units/L (normal: 0.11-0.60 units/L)
Prostate specific antigen (PSA)
1.0 ng/mL (normal: <4 ng/mL)
Prostate ultrasound
Diffusely enlarged prostate; no localized tumor
Diagnostic Analysis: Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. Urinary Obstruction Case Study Week 9
Critical Thinking Questions:
1. Does BPH predispose this patient to cancer?
2. Why are patients with BPH at increased risk for urinary tract infections?
3. What would you expect the patient’s PSA level to be after surgery?
4. What is the recommended screening guidelines and treatment for BPH?
5. What are some alternative treatments / natural homeopathic options for treatment?
ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERS
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.