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The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program. Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. “No Straight forward / Simple answer will be accepted”. Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement. All answers to case studies must have the references cited “in the text” for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition Urinary Obstruction Case Studies The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP), p. 1057 Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL, p. 701 8 mL/sec (normal: >12 mL/sec) Cystometry, p. 688 Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle, p. 554 Normal resting bladder with a positive tonus limb Cystoscopy, p. 598 Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP), p. 25 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA), p. 420 1.0 ng/mL (normal: <4 ng/mL) Prostate ultrasound, p. 891 Diffusely enlarged prostate; no localized tumor Diagnostic Analysis Because of the patient's symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. Critical Thinking Questions Does BPH predispose this patient to cancer? Why are patients with BPH at increased risk for urinary tract infections? What would you expect the patient's PSA level to be after surgery?

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