Question

Case Study #47 A 68-year-old man presents to the physician with a complaint of urinary frequency. He states that he has noted increased urgency and frequency for approximately 1 year, but his symptoms have become progressively worse. He states that currently he seems to have to urinate "all the time" and often feels as if he has not completely emptied his bladder. He must get up to urinate three or four times each night. In addition, in the last month, he sometimes has postvoid dribbling. He denies fevers, weight loss, or bone pain. His medical history is notable only for hypertension. His medications include atenolol and aspirin. The family history is negative for malignancy On examination, he appears healthy. His vital signs are notable for a blood pressure of 154192 mm Hg. Prostate is diffusely enlarged without focal nodule or tenderness. Benign prostatic hyperplasia is suspected. Questions 1. How would you make the diagnosis of benign prostatic hyperplasia? 2. What factors are known to be responsible for the pathogenesis of this disorder? 3. How would you classify this patient's symptoms? What is the mechanism by which benign prostatic hyperplasia causes these symptoms?

Answer 1

The prostate is a gland that is only present in males and is located between the bladder and penis.The prostate is located just infront of the rectum.The urethra runs through the center of the prostate,from the bladder to the penis.The main function of the prostate is,it secretes a fluid called prostate fluid that helps in nourishment and protection of the sperm.

The acronym used for Benign Prostatic Hyperplasia is BPH, or simply we can say it as a prostate gland enlargement.

1.

1).The main part of the diagnosis is taking a medical history including the symptoms and digital rectal examination,by inserting the gloved finger in to the rectum to detect for any abnormality of shape,and thickness of the prostate.

2).Elevated Prostate-Specific Antigen levels or PSA blood test

3).Post-void residual volume (PVR),to measure urine left in the bladder after urination.it is one of the most symptoms of BPH

4).Uroflowmetry to knows the rate of urine flow

5).Cystoscopy

6).Ultrasound of the prostate

7).Urodynamic pressure,to measure the pressure of urine flow while urinating

2.

The actual reason for the BPH is not known.But it is a truth that it occurs only in older men.Some factors that may be responsible for the BPH are thought to be:

*Higher proportion of estrogen and declined levels of testosterone.Normally during the middle age there is a increased amount of active testosterone and smaller amounts of estrogen.During the old age there is declined levels of active testosterone that resuts in increased amount of estrogen that resuts in abnormal prostate cell growth

*Increased levels of dihydrotestosterone (DHT) and decreased levels of testosterone promotes the high levels of accumulation of DHT in prostate leads to abnormal prostate cell growth

*The other risk factors for BPH are :

$\small \rightarrow$ family history of BPH

$\small \rightarrow$ aging

$\small \rightarrow$ obesity

$\small \rightarrow$ lackof physical activity

3.

Due to the increased size of the prostate gland $\small \rightarrow$ compression of the bladder $\small \rightarrow$ blocks or irritation of the bladder (why because it is located between the bladder and penis) $\small \rightarrow$ frequent urination with incomplete emptying of bladder

The frequency of urination is mostly occuring during the night,may be every one to two hours (nocturia)

*Feeling of bladder fullness even after urination due tolarge prostate compression over the bladder results in incomplete emptying of bladder

*Feeling of urination all the time

*Increased urgency

*Post-void dribbling of urine

*Trouble in starting urination

*Strain on urination

*Weak flow of urine while urinating

*Inability to completely empty the bladder

The all above symptoms are results from from the bladder oulet obstruction due to the enlarged prostate that compress the bladder.