Urinary Obstruction

Case Studies

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.

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?

Rough Draft of Assignment 1: Project Paper – Comparative Essay

Final submission is due in Week 4 and worth 190 points (This is your rough draft and you will be awarded 5 bonus points by using Ecree)

For this assignment, you’re going to compare two rulers. Select a group of either two male rulers or two female rulers from different cultures using the following list:

Ancient Male Rulers: Ramses II, Shihuangdi, Constantine, Ashoka, Pericles, or Charlemagne

Ancient Female Rulers: Compare Tang Empress Wu Zetian (Chinese Culture) with either the Pharaoh Cleopatra (Egypt Culture) or the Pharaoh Hatshepsut (Egypt Culture)

Note: Empress Wu Zetian is also known as  Empress Wu or as Wu Zhao

Write a 750-1000 word essay where you:

Paragraph 1: Establish a clear thesis about your chosen subjects. Include the dates in which each lived and ruled, and add 2-3 sentences on the reason for each choice.

Paragraph 2:  Compare 2 ways your choices are similar.

You may compare their family background, leadership styles, accomplishments, victories, losses, or impact of the culture in which each lived.

Paragraph 3: Compare 2 ways your choices are different.

You may compare their family background, leadership styles, accomplishments, victories, losses, or impact of the culture in which each lived.

Paragraph 4:  Compare 2 ways your choices’ cultures are different.

You may compare their cultural differences in terms of government structure, religion, natural resources, traditions, or goods and services.

Paragraph 5: In a concluding paragraph, summarize 2 things you learned about leadership styles or cultures then compared to leadership styles or cultures today.

References: Include a reference page that identifies at least 3 references.

The class text may be included in the list of 3 or more.

In-text citations are required when paraphrasing or quoting another source.

Formatting and Writing Standards: Align your formatting to the Strayer University Writing Standards. View the: Strayer University Writing Standards (SWS)