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 nega

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:

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:

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.

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?

Note: I need you to have at least two to three bibliographic references and ask that they be updated, less than 5 years ago.