Discussion: Urinary Frequency
In this case study, I will discuss the case of a 52-year old African-American male client who presents with complaints of urinary frequency and nocturia. He reports that he has had the symptoms for a couple of months, which have worsened in the past week, making it difficult to sleep due to the urinary frequency. Besides, there is a family history of Hypertension; he is a banker, does not smoke and drinks alcohol occasionally. Lastly, he demonstrates poor health-seeking behaviours and has no primary provider.
The probable diagnosis for this case is Benign Prostatic Hyperplasia (BPH). BPH is a condition where the cells of the prostate over divide, resulting in an enlargement of the prostate gland (Kim, Larson & Andriole, 2016). It mostly affects men from the age of 50 years and manifests with urinary symptoms. The common symptoms include sudden urgency to urinate, increased urinary frequency during daytime and at night (nocturia) and difficulty in initiating and maintaining urination (Strope, 2018). Furthermore, there is incomplete emptying of the urinary bladder during micturition, consequently leading to the feeling of urination irrespective of the actual urination.
- Overactive bladder (OAB). OAB is a disorder that presents with sudden irresistible need to urinate. The hallmark characteristic of OAB is urinary urgency during the day and at night (Eapen & Radomski, 2016). Besides, the need to urinate is uncontrollable and often results in the dribbling of urine.
- Urinary Tract Infection (UTI). UTI is characterized by pain during micturition (dysuria), which is a common symptom. It also presents with urine dribbling, increased frequency in micturition and urinary urgency. In addition, the condition is uncommon in males below 50 years of age; however, the rate of infection rises after 50 years.
- Chronic Bacterial Prostatitis (CBP). Bacterial Prostatitis is characterized by inflammation of the prostate gland as a result of a bacterial infection. The common bacteria is Escherichia coli and usually affects males between the ages of 35 to 50 years (Gill & Shoskes, 2016). The acute stage is characterized by severe symptoms such as urinary urgency and frequency, nocturia, fever and complete inability to pass urine due to blockage of the urinary system (Gill & Shoskes, 2016). The chronic stage is less severe, develops gradually and lasts for more than three months.
Role of Patient History and Physical Exam in Diagnosis
The history of present illness helped in establishing the duration of presenting symptoms, severity and the effect of the signs to the patient’s quality of life. The family history further facilitated in identifying hereditary chronic conditions such as hypertension or diabetes mellitus which predispose one to the risk of BPH (Strope, 2018). Besides, the history revealed the patient’s health-seeking patterns and social support system. Moreover, the social history helped to establish if the cause of the symptoms was as a result of the patient’s occupation or lifestyle. Additionally, a focused physical examination of the genito-urinary system helped to assess for signs of a distended urinary bladder (Kim, Larson & Andriole, 2016). Lastly, a digital rectal examination was essential to estimate the size of the prostate gland and any abnormalities and diagnose prostatic hyperplasia.
Potential Treatment Options
I will prescribe Alfuzosin 10mg O.D. for six months. Alfuzosin is a selective alpha-1-blocker of prostate adrenoreceptors, which act by relaxing the smooth muscles in the neck of the bladder and prostate (Davidian, 2016). The relaxation of muscles results in enhanced urine flow and reduce BPH symptoms. I will also prescribe Finasteride 5MG O.D. for six months. Finasteride acts by inhibiting the formation of Dihydrotestosterone (DHT) resulting in the shrinking of the prostate gland (Davidian, 2016). This further eases the process of micturition and increases the urine flow rate.
Davidian, M. H. (2016). Guidelines for the treatment of benign prostatic hyperplasia. U.S. Pharm, 41(8), 36-40.
Eapen, R. S., & Radomski, S. B. (2016). Review of the epidemiology of overactive bladder. Research and reports in urology, 8, 71.
Gill, B. C., & Shoskes, D. A. (2016). Bacterial Prostatitis. Current opinion in infectious diseases, 29(1), 86-91.
Kim, E. H., Larson, J. A., & Andriole, G. L. (2016). Management of benign prostatic hyperplasia. Annual Review of Medicine, 67, 137-151.
Strope, S. A. (2018). Evidence-based guidelines in lower urinary tract symptoms secondary to benign prostatic hyperplasia and variation in care. Current opinion in urology, 28(3), 262-266.
Discussion : Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Discussion: Urinary Frequency Case Study 1
A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.
Case Study 2
This is a 40 year old Hindu married male complaining of sudden high grade fever for the last 2 days. He is complaining of right flank pain with some burning on urination. PMH: diabetes, HTN. Current meds: metformin 500mg bid, Lisinopril 10mg QD
Discussion: Urinary Frequency Case Study 3
A 52 year old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s loss at least “10 pounds”. For the past week and a half she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20 year history of Crohn’s disease. She also tells you that she is a practicing vegan.
Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Discussion.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient. Discussion: Urinary Frequency
Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
Think about potential treatment options for the patient.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Respond to questions posed to you during the week.