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Benign Prostatic Hyperplasia
BPH Benign increase in
size of prostate Hyperplasia of
stromal and epithelial cells
Nodules
Patient W.M. 76 yo Recurrent UTIs Acute pyelonephritis Urinary frequency, urgency,
incontinence, and nocturia
Past Medical History Hypothyroidism COPD Obesity 1 ppd smoker Father – alcoholic Mother – DM type 2
Review of Symptoms Strain to initiate urination Urinary flow stops and then starts Post-void dribbling
Medications Ipratropium bromide Ibuprofen Levothyroxine Ferrous sulfate
Case Question 1:For what condition is the patient probably taking ipratroprium bromide?
Ipratropium bromide is used to relieve bronchial spasms
Anticholinergic
Answer:
COPD
Case Question 2:For what condition is the patient probably taking levothyroxine?
Synthetic thyroid hormone
Answer:
Hypothyroidsim
IPSS International Prostate Symptom Score 8 question survey Standardize patients
Case Question 3:Based on the patient’s IPSS, is his condition of prostatic enlargement considered mild, moderate or severe?
Case Question 4:Based on the patient’s BMI, is the patient technically overweight or obese?
BMI Measure of body fat
Underweight < 18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity > 30
Vital Signs
Patient’s BMI = 33.8%
BP 135/85 (R arm) 130/85 (L arm)
RR 16, unlabored HT 6’0”
P 80 and regular T 98.6 F WT 249 lbs
Physical Exam All normal Urinary Function Tests
Uroflowmetry Transabdominal ultrasound Pressure flow study
Case Question 5:Which urinary function test(s) is/are consistent with an enlarged prostate?
Uroflowmetry Normal: 10 – 21 mL/sec Patient: 7 mL/sec
Residual Urine Volume > 50 mL significant Patient: 110 mL
Bladder Voiding Pressure Weak < 100 cm H2O
Patient: 74 cm H2O
Case Question 6:Identify all abnormal results of this patient’s urinalysis
Color Straw
Bilirubin (-)
WBC 2/HPF
Appearance Clear Ketones (-)
RBC 2/HPF
SG 1.017
Blood (-)
Bacteria Trace
pH 6.4
Urobilinogen (-)
Crystals (-)
Glucose (-)
Nitrites (-)
Culture Not indicated
Blood Test ResultsNa 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
Case Question 7:Is the patient experiencing an electrolyte imbalance?
Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
8. Renal Function?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
9. Hepatic Function?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
10. Hb, Hct, MCV, MCH, MCHC?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
11. T4 and TSH?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
12. Single most significant result?Na 141 meq/L
MCHC 31.8 g/dL
LDH 219 IU/L
K 3.9 meq/L
Plt 282000/mm3
Bilirubin 1.2mg/dL
Cl 109 meq/L
WBC 8700/mm3
Protein 5.9mg/dL
HCO3 32 meq/L • Neutros 65%
Cholesterol 255mg/dL
BUN 15 mg/dL
• Lymphs 27%
Ca 8.7mg/dL
Cr .8 mg/dL
• Monos 5%
Mg 2.2mg/dL
Glu 119 mg/dL
• Eos 2%
PO4 2.8mg/dL
Hb 13.9 g/dL
• Basos 1%
Uric acid 6.3mg/dL
Hct 41%
AST 31 IU/L
T4 3.5µg/dL
MCV 97 fL
ALT 41 IU/L
TSH 107.9µU/mL
MCH 28.7 pg
Alk phos 52 IU/L
PSA* 5.2ng/mL
*PSA 13 months ago was 5.0 ng/mL
Case Question 13:Provide three strong lines of evidence that this patient does not have prostate cancer
1. Low PSA
1. Physical exam findings
1. Low WBC count
Case Question 14:Pharmacotherapy or surgery?
Case Question 15:When a patient with mild-to-moderate BPH does not respond to pharmacotherapy with 5α-reductase inhibitors or α1-blockers, what can be inferred?
the end
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