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Evaluation of Chronic Frequent Urination in a 65-Year-Old Male – A Case Study

Evaluation of Chronic Frequent Urination in a 65-Year-Old Male – A Case Study

The presentation of a 65-year-old male who is experiencing frequent urination without pain or other associated symptoms has possibilities of several different diagnoses. Due to the patient’s age and the DRE findings of an enlarged, firm, smooth, and symmetrical prostate, Benign Prostatic Hyperplasia (BPH) is the most probable diagnosis. BPH, a relatively common condition in men as they age, refers to the noncancerous enlargement of the prostate gland that frequently results in lower tract symptoms such as increased urinary frequency (Ng & Baradhi, 2022). The presented case illustrates the necessity of combining clinical history and physical examination results to make the proper diagnosis and develop a treatment plan.

Differential Diagnoses

Overactive Bladder (OAB)

Very often, overactive bladder syndrome (OAB) occurs in the presented situation which is defined as urgent, frequent urination with accompanying nocturia and a sensation of bladder remaining incomplete (Scarneciu et al., 2021). Distinct from BPH, which typically results in voiding difficulties, OAB is usually characterized by storage problems. With the same urinary symptoms, it might be advantageous to evaluate urodynamic studies to know whether the problem is BPH or OAB precisely.

Urinary Tract Infection (UTI)

The fact that there is no pain or hematuria present in the urine is not enough to rule out the possibility of urinary tract infection (UTI). Since the patient presents with frequent urination symptoms, it would be necessary to conduct tests like urinalysis or urine culture to either confirm or exclude UTI (Kaur & Kaur, 2020). Even without typical symptoms such as dysuria or hematuria, UTI may reveal itself via atypical manifestations, oftentimes in older people. Therefore, careful assessment is needed to avoid missing this possible diagnosis.

Diabetes Mellitus

Diabetes mellitus is a relevant factor to take into account because uncontrolled diabetes can cause symptoms such as frequent urination, as indicated by Goyal et al. (2023). Though BPH and diabetes are dealt with as separate entities, it is essential to understand that diabetes can be a contributing factor to the urinary symptoms in this case. Glucose testing and detailed physical examination are necessary to rule out the possibility of diabetes mellitus. Although these are not typical diabetes symptoms, like polyuria and polydipsia, atypical presentations are still possible, especially in the elderly.

Therapeutic Plan

The management of BPH typically follows evidence-based clinical guidelines, commencing with lifestyle changes and proceeding to pharmacological interventions if necessary. It includes:

Lifestyle Modifications

Lifestyle modification is essential in managing benign prostatic hyperplasia (BPH). Talking the patient through the reduction of caffeine and alcohol intake, as well as creating a regular voiding timetable, significantly relieves the symptoms and improves the quality of life (Miernik & Gratzke, 2020). Caffeine and alcohol intake in limited amounts can reduce bladder irritation and urgency and a structured voiding schedule facilitates bladder emptying, helping to decrease the frequency of urination episodes.

Pharmacological Intervention

In case lifestyle modifications do not provide the desired relief, the use of pharmacotherapy to treat BPH is imperative. Miernik & Gratzke (2020) indicate that the options for treatment are alpha-1 blockers, which include terazosin, 5-alpha reductase inhibitors that are finasteride, phosphodiesterase inhibitors like Tadalafil, anticholinergics such as Fesoterodine, beta-3 agonists, or combination therapies. The choice of drugs should be based on the patient’s circumstances and medical records. Considerations like symptom severity, co-existing conditions, possible side effects, and drug interactions should be considered to achieve higher efficacy and reduce adverse events, leading to better outcomes and patient satisfaction.

Monitoring and Follow-Up

Continuous monitoring and individual follow-up visits are of utmost importance in managing benign prostatic hyperplasia (BPH) (Miernik & Gratzke, 2020). These attendances enable providers to evaluate the effectiveness of the treatment and make necessary corrections. Additionally, monitoring the progression of symptoms allows physicians to consider interventions promptly. If a procedure or surgery is needed, it can be done to improve patient outcomes.

References

Goyal, R., Jialal, I., & Singhal, M. (2023, June 23). Diabetes mellitus type 2. National Center for Biotechnology Information; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/

Kaur, R., & Kaur, R. (2020). Symptoms, risk factors, diagnosis, and treatment of urinary tract infections. Postgraduate Medical Journal, 97(1154), postgradmedj-2020-139090. https://doi.org/10.1136/postgradmedj-2020-139090

Miernik, A., & Gratzke, C. (2020). Current treatment for benign prostatic hyperplasia. Deutsches Aerzteblatt Online, 117(49). https://doi.org/10.3238/arztebl.2020.0843

Ng, M., & Baradhi, K. M. (2022). Benign Prostatic Hyperplasia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558920/

Scarneciu, I., Lupu, S., Bratu, O., Teodorescu, A., Maxim, L., Brinza, A., Laculiceanu, A., Rotaru, R., Lupu, A.-M., & Scarneciu, C. (2021). Overactive bladder: A review and update. Experimental and Therapeutic Medicine, 22(6). https://doi.org/10.3892/

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Question 


A 65-year-old male presents to your clinic with frequent urination. He complains of painless, frequent urination approximately every 45 minutes to an hour for the past 5 months. He states he hates visiting doctors because they always try to find something wrong with him. His wife made him this appointment, but he thinks his problem is just because he is getting older. He denies any pain on urination or any blood in the urine. He also denies any difficult voiding. No foul odor is in the urine or discharge from the penis. He has tried to reduce his liquid consumption, but it has not made much of a difference.

Evaluation of Chronic Frequent Urination in a 65-Year-Old Male - A Case Study

Evaluation of Chronic Frequent Urination in a 65-Year-Old Male – A Case Study

He denies any pelvic pain or rectal pain. He has not had any labs done in the past 5 years. Also, he has not had a physical done in 10 years. A physical exam reveals an African American male in no apparent distress. The abdomen is soft, and nontender, with no masses or distensions on palp. No hepatosplenomagaly. DRE reveals an enlarged, firm, smooth, symmetrical prostate. Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.