Respond to the following discussion post. References should be no older than 5 years.
Week 5 Discussion: GU Case Study
Case Study: 65-year-old male presenting with urinary frequency.
Subjective data: Patient presents for the evaluation of urinary frequency for the last five months. States having the urge to void every 45 to 60 minutes. The patient denies dysuria, hematuria, penile discharge, or difficulty voiding.
Objective data: African American male in no acute distress. Unremarkable abdominal exam. Digital rectal exam reveals an enlarged prostate; however, prostate is smooth and symmetrical.
Differential Diagnoses: Benign Prostatic Hyperplasia (BPH), Prostate Cancer (PC), Urinary Tract Infection (UTI).
Based on the history of present illness and physical exam of the patient, the most likely diagnosis is BPH. However, it is key for the clinician to rule out the other possible diagnoses such as PC and UTI, which require immediate intervention. During this visit the clinician should obtain a history, order diagnostics, and provide treatment and lifestyle modification suggestions.
To start, the clinician should obtain a thorough history to evaluate potential risks of prostate enlargement such as obesity, diets high in fat and red meats, or medications that can cause urinary retention such as anticholinergics (e.g., Bentyl) (Russo, 2021). The clinician should further investigate if there is a history of cancer in the family or known prostate problems. Also, a detailed history of progression of symptoms should be obtained.
Diagnostics should include CBC, CMP, PSA, UA and culture, post-void residual bladder US (Leslie, et al., 2022). The UA and culture can aid in ruling out a UTI, the provider should rule out infectious process that may be causing the symptoms. The DRE reveled an enlarged prostate, otherwise with normal borders and smooth, which is reassuring (Ng, et al., 2022). However, a PSA should be ordered, as a result lower than 10 can help in ruling out prostate cancer (Leslie, et al., 2022). The post-void US can provide the clinician with a quantitative value of urine left in bladder, to determine if emptying the bladder is the issue, which correlates with BPH (Ng, et al., 2022).
It is to note, the treatment provided should be the one that suites the patient the best, along with sustaining evidence of effectiveness. The patient noted he hates visiting the doctor as they always tend to look for something wrong. The provider can expect the patient may be reluctant to start medications and should offer other alternatives for the treatment of BPH, such as lifestyle modifications and natural supplements. The patient can be recommended to use pumpkin seed extract or oil, consume more tomatoes, rye pollen, and saw palmetto fruit as these have been used as natural treatment for BPH (Csikos, et al., 2021). The clinician should also recommend lifestyle modifications such as weight loss, decreasing high ingestion of fats and red meats, avoiding caffeine, and decreasing alcohol intake (Ng, et al., 2021). If the patient decides to try medical treatment, the provider can start by prescribing an alpha blocker, such as tamsulosin, 0.4mg once a day (McVary, 2022). Finally, the patient should be instructed to return to the clinic or to an emergency department if worsening symptoms present, such as hematuria, dysuria, flank pain, fevers or chills.
References
Csikós, E., Horváth, A., Ács, K., Papp, N., Balázs, V. L., Dolenc, M. S., Kenda, M., Kočevar Glavač, N., Nagy, M., Protti, M., Mercolini, L., Horváth, G., & Farkas, Á. (2021). Treatment of benign prostatic hyperplasia by natural drugs. Molecules, 26(23), 7141. https://doi.org/10.3390/molecules26237141
Leslie, S. W., Soon-Sutton, T. L., Sajjad, H., & Siref, L. E. (2022). Prostate cancer – statpearls – NCBI bookshelf. Retrieved July 29, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK470550/
McVary, K. T. (2022). Medical treatment of benign prostatic hyperplasia. UpToDate. Retrieved July 28, 2022, from https://www.uptodate.com/contents/medical-treatment-of-benign-prostatic-hyperplasia#H3844110615
Ng, M., & Baradhi , K. (2022). Benign prostatic hyperplasia – statpearls – NCBI bookshelf. Retrieved July 29, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK558920/
Russo, G., Broggi, G., Cocci, A., Capogrosso, P., Falcone, M., Sokolakis, I., Gül, M., Caltabiano, R., & Di Mauro, M. (2021). Relationship between dietary patterns with benign prostatic hyperplasia and erectile dysfunction: A Collaborative Review. Nutrients, 13(11), 4148. https://doi.org/10.3390/nu13114148
