70-year-old - elderly, immunocompromised, common health issue(DM,Heart disease),normal aging process can lead to incrased bladder contractibility,decrease bladder compliance,resulting in urgency and frequency

male - male disease (prostate ca)

urinary frequency, urgency, and hesitancy - caused by uti,overactive bladder,medication side effects,bladder muscle problem

UTI

Lower urinary tract syndrome

Obstruction of UT

Trauma involving UT

Kidney stone

Enlargement of prostate(d/t Prostate CA or medication)

Prostatitis

DM

Aging related - Muscle weakness(inner sphincter and external sphincter)

Onset - gradual(BPH/overactive bladder/Neurological issue) or sudden(UTI/Prostatitis)

Characteristics- urine- large amount or small amount? have to get up at night?colour? odour? pain whne urinating?

Associated symp-fever?swelling in extremities? weight loss? loss of appetite?

Pain- difficulty starting to urinate d/t pain,ask on characteristic of pain(sharp/dull/intermittent)

Timing - constatnt or intermittent,changes in severity of symp.

Exacerbating/Relieving factor- any food/medication taken that may have made the condition worse or better

PMH - History of UTI,surgeries(urinary catherization)

Medication history- diuretics?

Allergy history

Family history - similar symp in family members?history of prostate problem,endocrine disorders,UTI

Social history- occupation(dehydration,unhygenic-UTI),dietary(oxalate rich food-kidney stone),Alcohol and smoking

Marital status/sexual activities

UTI

Lower urinary tract syndrome

Obstruction of UT

Trauma involving UT

Kidney stone

Enlargement of prostate(d/t Prostate CA or medication)

Prostatitis

DM

Aging related - Muscle weakness(inner sphincter and external sphincter)

DRE - examine lower rectum, anus, prostate gland

Perineal sensation - sensory perception at the perineal, between anus and penis

Vital signs - temperature normal - no infection, HR normal -normal cardiac fx, RR and BP normal (under control)

no costovertebral angle tenderness - no kidney problem

bladder felt distended on palpation - bladder enlarged - holding more urine than normal - incomplete emptying (can be normal if the bladder is full) - ask patient empty the bladder first before the examination (depends on test - best to have full or empty bladder)

genital exam is normal - genital no scars, no lesions and mass

Digital rectal examination reveals a prostate is enlarged in size, smooth, and non- tender with no nodules --> possible prostate problem - prostate cancer may have irregularities on palpation, prostatitis also can cause non-cancerous nodules

anal sphincter tone and perineal sensation is normal - no neurological condition

UTI

Lower urinary tract syndrome

Obstruction of UT

Trauma involving UT

Kidney stone - loin to groin pain, positive murphy sign

Enlargement of prostate(d/t Prostate CA or medication)

Prostatitis

DM

Aging related - Muscle weakness(inner sphincter and external sphincter)- normal

Blood test (FBC)

Blood glucose

Urinalysis - composition of urine

Renal function test - assess in FBC

PSA test

Prostate biopsy (but invasive)

Imaging - ultrasound, MRI

IPSS score - international prostate symptoms score, to assess severity of symptoms in bph

postvoid residual urine volume (PVR) - amount of urine left in the bladder after voiding

blood test

• All normal, no anaemia, no infection, no bleeding disorder, normal kidney function

His IPSS score was 21 and prostate specific antigen was 4.2 ng per mL

• 21: severe lower urinary tract symptoms

• PSA: more than 50 normal is 4.0

• PSA 4-10 suspicious of 25% chance of prostate ca

Ultrasound scan showed an enlarged prostate gland measuring 55 cc in volume postvoid residual urine volume (PVR) of 60 mL

• confirm prostate enlargement (normal:20-25 cc)

• PVR: less than 50ml is normal, indicate patient has urinary retention due to obstruction by enlarged prostate

Transrectal ultrasound-guided prostate biopsy showed benign prostatic tissue with stromal and glandular hyperplasia

• non-cancerous tissue

diagnosed with benign prostate hyperplasia

• prostate enlarged but not cancerous

• occur in elderly men

started medication therapy with tamsulozin and finasteride

• to treat bph

• tamsulozin: relax muscle of prostate and bladder

• finasteride: shrinking prostate, decrease dht

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

• good prognosis

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

• to monitor progression of the disease