Introduction
Urinary frequency is a disorder that can signify a range of other problems in a patient. It may be connected to other genitourinary conditions as well as cardiovascular and hormonal issues (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Therefore, it is vital for a nurse to ask many questions about the patient’s health to narrow the selection of diagnoses. For example, to examine the patient’s present illness, such information as the amounts of consumed and voided liquid is necessary. Other questions include the presence of other symptoms and recent sexual activity. The patient should share which medications he takes and whether he has hypertension or cardiac failure. Data that is currently available may be a basis for such diagnoses as benign prostatic hyperplasia (BPH), overactive bladder syndrome (OBS), prostatitis, and a urinary tract infection (UTI).
Primary Diagnosis: Explanation and Treatment
The primary diagnosis for this patient is benign prostatic hyperplasia (BPH). It is a condition that often occurs in older men. BPH is an enlargement of the prostate which, as a result, obstructs the regular work of the urinary tract. The common symptoms of BPH are urinary frequency, nocturia, dribbling, incomplete voiding, weak urine stream, and difficulty starting urination (Speakman, Kirby, Doyle, & Ioannou, 2015). Moreover, the signs of BPH progress with time, which is also seen in the patient’s case. Overall, the patient’s complaints align with this diagnosis that can be supported by such diagnostics as cystometry, ultrasonography, and rectal examination (Speakman et al., 2015). Urine and blood tests may also help rule out other diagnoses or show kidney problems. Finally, the patient will be asked to keep a voiding diary for 24 hours, documenting the frequency and amount of urine.
The treatment of BPH depends on the specific case of the patient. For example, some men require surgery to relieve the symptoms, while others get better on their own. If the patient has mild to moderate symptoms, one can prescribe alpha-blockers, such as Alfuzosin, 10 mg orally once a day after the same meal (“Alfuzosin,” 2018). If the patient’s condition deteriorates, it may serve as a sign of another problem– prostate cancer. However, early testing is burdensome and stressful, and, therefore, discouraged (Marroquin, 2011). Lifestyle changes are to limit alcohol and caffeine consumption, not drink liquids before sleep, and stay active.
Differential Diagnoses
- The first differential diagnosis is overactive bladder syndrome (OBS), otherwise known as bladder detrusor overactivity. It is characterized by nocturia, frequency, and a weak urinary stream. A defining trait is an urgency – people with OBS feel a sudden need to urinate throughout the day. It is also often followed by urge incontinence when one experiences an involuntary leakage of urine (Goldman et al., 2016). Cystometry can help diagnose or exclude this condition, but the patient’s lack of reported incontinence weakens the probability of this diagnosis.
- The second possible differential diagnosis is prostatitis, an inflammation of the prostate gland. It leads to people experiencing pain and burning sensations during urination. Other symptoms include nocturia, frequency, difficulty urinating, urgency, perineum, and testicular pain, as well as bloody or cloudy urine (Coker & Dierfeldt, 2016). The patient does not report any discharge in urine or signs of an infection (fever, chills, pain). A urine culture test and rectal examination should rule out this condition.
- Finally, one may consider a urinary tract infection (UTI) as a differential diagnosis. UTIs are followed by dysuria, fever, pain, frequency, and foul-smelling urine (Grabe et al., 2015). This diagnosis can be confirmed or disproven with urinalysis and culture tests for sexually transmitted infections.
Conclusion
A variety of conditions may cause the patient’s symptoms, and only a part of these disorders is connected to genitourinary problems. Additional history should be collected to reveal potential cardiovascular or renal concerns. Based on the currently available information, the primary diagnosis is BPH, and differential diagnoses are OBS, prostatitis, and UTIs. Treatment options for BPH vary, but medical therapy with alpha-blockers is the first step for regulating symptoms.
References
Alfuzosin dosage. (2018). Web.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Coker, T. J., & Dierfeldt, D. M. (2016). Acute bacterial prostatitis: Diagnosis and management. American Family Physician, 93(2), 114-120.
Goldman, H. B., Anger, J. T., Esinduy, C. B., Zou, K. H., Russell, D., Luo, X.,… Clemens, J. Q. (2016). Real-world patterns of care for the overactive bladder syndrome in the United States. Urology, 87, 64-69.
Grabe, M., Bjerklund-Johansen, T. E., Botto, H., Çek, M., Naber, K. G., Tenke, P., & Wagenlehner, F. (2015). Guidelines on urological infections. European Association of Urology, 182, 237-257.
Marroquin, J. (2011). To screen or not to screen: Ongoing debate in the early detection of prostate cancer. Clinical Journal of Oncology Nursing, 15(1), 97–98.
Speakman, M., Kirby, R., Doyle, S., & Ioannou, C. (2015). Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) – Focus on the UK. BJU International, 115(4), 508-519.