urinary hesitancy - difficulty iniatiating micturition in delay onset of voiding after individual is ready to urinate

urinary frequency - need to urinate more often

urinary urgency - sudden urge to urinate w\o full bladder

70-year-old male presented - immunocompromised, htn, diabetes, prostate ca, conscious, elderly: degenaration of cells, loss of bladder control

chief complaint of urinary frequency, urgency, and hesitancy. - uti, diabetes (neurological problems), bph

waking up multiple times each night to urinate - nocturia, commo in older pt, when pt urinate a t least once or twice per night, causes, bladder infxn, alcohol, enlarge prostate gland, DM

symptoms began approximately 2 months ago - chronic

patient reports that he often has difficulty falling back asleep after awakening, and the loss of sleep was affecting his quality of life - dt nocturia, disrupt his leep pattern, insufficient sleep loss of energy for the next day, affect his daily activity

had a family history of prostate cancer and is concerned that prostate cancer is the source of his symptoms - risk to get prostate ca for first degree relative

The patient had a prostate exam including PSA blood test performed 15 years ago, with normal results - have no any signs of prostate ca at that time, still cant be urled out, prostae ca can develop gradually over time, increase with age, psa blood test not too accurate in detecting prostate ca, some med also can influence psa level, to ruled out this ca.. do DRE, biopsy

The patient was diagnosed with hypertension at age 55 and takes enalapril - not dierectly cause urinary sytem infxn, can influence prostate health, lead to htn related nephropathy, ada relation between HTN and prostate Ca (less evidence), enalapril ace inhibitors, ada side efects, persistent dry cough, can cause difficulty to sleep after nocturia, electrolyte imbalance, has renoprotective effects, having nocturia might cause HTN, insomnia, stress, when do psa with enalapril, false results

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 - has familial predisposition for prostate Ca, father: may suggest manageable (hidup lama), brother: concern, potentially more aggressive form of Ca, pt have high risk for prosta Ca

no known allergies revealed - allergies can impaired treatment decision

no history of smoking, alcohol consumption or drug abuse - the dx not iduced by these, maybe bcs of genetic, might no be complicated or worsen

costovertebral angle - aka renal angle, angle between lower border of 12 th rib and lateral border of erector spine muscle

DRE - check for rectum, anus and prostate gland abnormalities

perineal sensation - ability to percieve touch, pressure, pain and temp in perineal area, mediated by nerve including pedundel nerve (S2-S4)

all vital signs normal - bp normal means controlled hpt, temp normal absence of systemic infx, hr normal means no cvs event, rr normal so normal respiratory

no costovertebral angle tenderness - no kidney problem

bladder felt distended on palpation - bladder enlarged beyond normal size means bladder have lot of urine that not fully emptying, causes are bladder obstruction such as bladder stone, bladder tumor

genital exam normal - not enough to rule out prostate ca

DRE reveals prostate enlarged in size, smooth and non-tender with no nodules - more to BPH as no nodule (nodules more prominent for malignant), non-tender so painless (benign)

anal sphincter tone and perineal sensation is normal - no neurological dysfunction (more related to obstructive causes such as BPH)

PVR urine volume - amount of urine left after urination.

Blood test - Normal, Hb can rule out anemia, glucose rule out diabetes

Urinalysis - Normal, BPH does not cause uti, BPH does not associated with proteinuria.

IPSS score 21 and PSA 4.2 - Severe symptom, PSA also high, PSA also can elevate in normal condition sometimes does not indicate prostate CA.

Ultrasound enlarged prostate gland measuring 55 cc in volume and PVR 60 mL - Indicates benign hyperplasia.

Transrectal ultrasound-guided prostate biopsy showed benign prostatic tissue with stromal and glandular hyperplasia - No sign of prostate ca, glandular hyperplasia(enlargement of glandular tissue)

Diagnose with BPH - Condition in men which the prostate gland is enlarged.

Medication therapy tamsulosin and finasteride - Tamsulosin(alpha 1 blocker), finasteride(block testosterone production)

Follow up visit significant symptom improvement and life quality improvement and medication tolerated well. - after 1 week there is no side effects

Continue therapy with annual DRE and PSA -