Case Study Analysis – 60-year-old Male Patient with Urinary Frequency and Incontinence

Case Study Analysis – 60-year-old Male Patient with Urinary Frequency and Incontinence

A 60-year-old male patient exhibits various symptoms in the presented case study. These include urinary frequency and incontinence after undergoing chemo and radiation therapy for prostate cancer, as well as persistent low back and hip pain that adversely affects his sleep. The patient’s laboratory results reveal a comprehensive assessment of their urinary system through a routine urinalysis, a thorough evaluation of their blood composition via a complete blood count (CBC), and an assessment of their prostate health by measuring the prostate-specific antigen (PSA) level, which is recorded at 7.2. The digital rectal examination (DRE) unveils the presence of an enlarged prostate characterized by the formation of nodules. Furthermore, the X-ray imaging of the lumbar spine showcases subtle degenerative alterations and the identification of a cystic mass near the spinal column. This comprehensive case study analysis will explore many pivotal facets of the patient’s presenting symptoms.

Factors Affecting Fertility (STDs)

The patient’s urinary symptoms may be related to the history of chemo and radiation therapy, which can cause damage to the genitourinary system. While not explicitly mentioned, sexually transmitted diseases (STDs) can impact fertility. STDs, such as chlamydia and gonorrhea, can lead to pelvic inflammatory disease (PID) in women (Smolarczyk et al., 2021; Van Gerwen et al., 2022). In PID, inflammation can damage the fallopian tubes, potentially causing infertility. It is essential to consider the patient’s sexual history and evaluate the potential role of STDs in his symptoms.

Inflammatory Markers in STD/PID

Elevated levels of inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, have been observed to exhibit a notable increase in reaction to instances of infection or inflammation (Greydanus & Bacopoulou, 2019). In the context of STDs and PID, it is noteworthy that the levels of inflammatory markers exhibit an upward trend due to the immune system’s diligent reaction to combat the infection. In the female demographic, the absence of medical intervention in the case of STDs can give rise to PID, thereby instigating an inflammatory response within the reproductive organs. The immune response elicits the liberation of these inflammatory markers, thereby facilitating the diagnostic process of PID.

Prostatitis and Infection

The patient’s enlarged, nodular prostate and urinary symptoms may indicate prostatitis, which can be caused by bacterial infection. Prostatitis is often accompanied by systemic symptoms, such as fever, chills, and malaise, indicative of a systemic reaction to infection (Mayo Clinic, 2022). The patient’s lower back and hip pain could also be related to prostatitis, as prostate inflammation can radiate pain to surrounding areas. It is crucial to assess for the presence of infection and initiate appropriate treatment, which may include antibiotics.

Splenectomy after ITP Diagnosis

The case study does not provide information regarding a splenectomy, but it is mentioned that the patient had a PSA of 7.2, indicating potential prostate issues. Splenectomy is not a standard treatment for prostate conditions. However, a splenectomy may be considered in cases of immune thrombocytopenic purpura (ITP), which was not mentioned in this case (Chaturvedi et al., 2018). ITP is an autoimmune disorder characterized by low platelet counts, and the spleen can be a site of platelet destruction. In severe cases of ITP, the removal of the spleen (splenectomy) can be necessary to increase platelet counts.

Anemia and Its Types

Anemia is a pathological state characterized by a diminution in erythrocytes or hemoglobin concentrations within the circulatory system. Anemia can be categorized into two primary classifications: microcytic and macrocytic. Microcytic anemia is characterized by abnormally small red blood cells. This phenomenon may arise due to iron deficiency, thalassemia, or other hereditary disorders (American Society of Hematology, 2021). Further diagnostic tests are necessary to ascertain the precise etiology of microcytic anemia.

Macrocytic anemia, on the other hand, is distinguished by the presence of abnormally enlarged red blood cells. This form of anemia can arise from vitamin B12 or folic acid deficiencies and specific medications. Determining the root cause of macrocytic anemia is crucial for implementing suitable therapeutic interventions.

In summary, this case study depicts an intricate clinical scenario involving various symptoms necessitating meticulous evaluation. A comprehensive investigation is warranted to ascertain the underlying causes and guide the appropriate treatment for the patient, taking into account their medical history of chemotherapy and radiation therapy, urinary symptoms, prostate issues, and systemic symptoms. Moreover, the patient’s prostate-specific antigen (PSA) level may serve as an indicator of potential prostate-related issues, thus necessitating further evaluation. The case study highlights the significance of considering various factors and conducting a thorough assessment to deliver the best possible care to the patient.

References

American Society of Hematology. (2021). Anemia. Www.hematology.org. https://www.hematology.org/education/patients/anemia

Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, 131(11), 1172–1182. https://doi.org/10.1182/blood-2017-09-742353

Greydanus, D. E., & Bacopoulou, F. (2019). Acute pelvic inflammatory disease. Pediatric Medicine, pp. 2, 36–36. https://doi.org/10.21037/pm.2019.07.05

Mayo Clinic. (2022). Prostatitis – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766#:~:text=Prostatitis%20is%20a%20disorder%20of

Smolarczyk, K., Mlynarczyk-Bonikowska, B., Rudnicka, E., Szukiewicz, D., Meczekalski, B., Smolarczyk, R., & Pieta, W. (2021). The Impact of Selected Bacterial Sexually Transmitted Diseases on Pregnancy and Female Fertility. International Journal of Molecular Sciences, 22(4), 2170. https://doi.org/10.3390/ijms22042170

Van Gerwen, O. T., Muzny, C. A., & Marrazzo, J. M. (2022). Sexually transmitted infections and female reproductive health. Nature Microbiology, 7(8), 1116–1126. https://doi.org/10.1038/s41564-022-01177-x

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A 60-year-old male presents to your clinic. He reports urinary frequency and incontinence since having his chemo and radiation therapy 3 years ago secondary to prostate cancer. Even though the symptoms are bothersome, he is more concerned about his lower back and hip pain, which began approximately one month ago, which he initially attributed to lifting heavy boxes. The pain is now constant and disrupts his sleep. Labs reveal a normal urinalysis and CBC, a PSA of 7.2. A DRE reveals an enlarged, nodular prostate. The x-rays of the LS spine are positive for mild degenerative changes and what appears to be a cystic mass near the spine.
An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.

Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

The factors that affect fertility (STDs).
Why inflammatory markers rise in STD/PID.
Why prostatitis and infection happen. Also, explain the causes of systemic reaction.
Why a patient would need a splenectomy after a diagnosis of ITP.
Anemia and the different kinds of anemia (i.e., micro and macrocytic).