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A 70-year-old male presented - immunocomp patient

complaint of urinary frequency, urgency, and hesitancy - naybe DM, overractive bladder, more suggest lower tract symptom

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Diagnosis

-DI/DM

- benign prostate hyperplasia

-UTI

-prostate cancer

inflammation of prostate

overreactive bladder

parkinson (nuero bladder dysfunc)

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-site - urge urinate felt lower of upper part

how long the symptom lasted

sudden or gradual

first symptom?

when pain?

C- colour of urine

amount of urine

urine odour

frequency hoe many times in a day

R- discomfort other part

radiate dri

A- weight loss, fever, hematuria, dysuria, nocturia

T - is the symptom constant or what?

E - any activity lead to urgency

caffeine / alchol intake (worst the symptom)

S - ask patient how the condition affect the daily life

PMH - pernah ada any UTI problem or any surgery

any underlying disease

drug use ( whether patient had CKD)

diuretic anticoli

any allergies

FH - malignancy

any member ( the same symptom)

SH - alcohol intake

active ke dulu?

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-patient stated that he was waking up multiple

times each night to urinate.

nocturia- excess urine production at night- common in bph patient- enlargemnet of uerthra can cause obstruction. aging cause less adh hormone. weakening of detrusor muscle

-The symptoms began approximately 2

months ago.

chronic, less like to be UTI, most likely to be BPH or prostate cancer

-The patient reports that he often has difficulty falling back

asleep after awakening, and the loss of sleep was affecting his quality of life.

patient facing insomnia, fatigue, BPH cause compression of urethra, increase urgency of urination, distrupt sleep

-The patient had a family history of prostate cancer and is

concerned that prostate cancer is the source of his symptoms.

more likely to get prostate cancer

-The patient had a prostate exam including PSA blood test performed 15 years ago, with normal results.

outdated result. family history suggest he is more likely to get prostate cancer

-The patient was diagnosed with hypertension at age 55 and takes enalapril.

ace inhibitor, can cause urinary symptom, can cause bladder and kidney symptoms

-His father was diagnosed with prostate cancer at 62,

died at age 86 and his brother was diagnosed with prostate cancer at age 43, still alive.

first hereditory malignancy, first degree relative, BRCA2 mutation

-There were no known allergies revealed.

no allergy reaction

- There was no history of smoking, alcohol consumption

or drug abuse.

bladder symptoms not due to drug or alcohol symp. probably genetic cause

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Diagnosis

-DI/DM

- benign prostate hyperplasia

-UTI

-prostate cancer

inflammation of prostate

overreactive bladder

parkinson (nuero bladder dysfunc)

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-vital signs

PE

- palpate lower abdomen to see any distended bladder (urinary retention) as patient complain frequency and hesitancy

-palpate renal angle, costovertebral angle : to check renal pain, inflammation, enlargement due to obstruction

-DRE : any tenderness or masses of prostate, asymmetrical enlargement, hemorrhoids, tone on anal spinchter, stool characteristics, blood in cauda equina

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-normal vital signs

-on physical examination, there was no costovertebral angle

pt got no inflammation in kidney

-tenderness and the bladder

felt distended on palpation.

presence of mass- suggest BPH

-His genital exam is normal.

rule out urethra testicular pathology

Digital rectal examination reveals a prostate is enlarged in size, smooth, and non-tender with no nodules.

-suggest BPH

-On neurologic exam, anal sphincter tone and perineal sensation is normal.

no neurological deficit, that affect bladder and bowel

-The rest of the examination was normal

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Diagnosis

- benign prostate hyperplasia

-prostate cancer (less likely)

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-FBC - to check inflammation

-urinalysis - check urine ontent

-serum PSA - to rule out malignancy

-PVR- if its high : obstruction

-ultrasound - enlargement or bladder, change in size of prostate

-IPSS - score to check prostate symprtoms :

1-7 : mild

8-19 - moderate

20-35 : severe

-cell biopsy

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-blood test normal

no inflammation or infection

-Urinalysis within normal range.

no inflammation or infection

-His IPSS score was 21 and prostate specific antigen was 4.2 ng

per mL

severe case of lower tract urinary symptoms

-Ultrasound scan showed an enlarged prostate gland measuring 55

cc in volume and postvoid residual urine volume (PVR) of 60 mL.

shows prostate hyperplasia, normal pvr

-Transrectal ultrasound-guided prostate biopsy showed benign

prostatic tissue with stromal and glandular hyperplasia.

features of BPH

-The patient was diagnosed with benign prostate hyperplasia, started

medication therapy with tamsulozin and finasteride.

tamsulozin : alpha blocker, relaxe smooth muscle in bladder

finasteride : block conversion of testesterone

-In follow-up visit after a week he reports significant symptom improvement and quality-of-life improvement and he tolerated the medications well.

-He was advised to continue therapy with annual DRE and PSA.