Benign Prostatic Hyperplasia

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The process of urination is vital to the body for the removal of certain waste products. Normally, when the bladder gets full, urine is emptied from the body through the urethra in a process called urination. In urinary retention, a person’s bladder fills up and there is an urge to urinate but he is unable to completely empty his bladder. With chronic urinary retention, a person may be able to urinate, but he has some trouble starting a stream or emptying your bladder completely. He may urinate frequently, may feel an urgent need to urinate but have little success when he gets to the toilet; or he may feel he still have to go after having finished urinating. With acute urinary retention, he can't urinate at all even though he has a full bladder. Acute urinary retention is a medical emergency requiring prompt action. Acute urinary retention (AUR) is an extremely uncomfortable and potentially life-threatening condition characterized by a sudden inability to urinate associated with intense suprapubic discomfort. It is most often secondary to obstruction, but may also be related to trauma, medication, neurologic disease, infection, and occasionally psychological issues. Acute urinary retention (AUR) is one of the most significant, uncomfortable and inconvenient event in the natural history of benign prostatic hyperplasia (BPH). BPH is the virtual universal overgrowth of the prostate gland in men as they age. Various factors affecting BPH are age, genetic makeup, testosterone levels, and environment. As the prostate enlarges it compresses the urethra causing obstruction to urine flow.  The urinary stream becomes smaller; there may be difficulty in initiating the stream, dribbling, and intermittent flow, frequency of urination, getting up at night to void (nocturia), inability to empty, or even inability to void at all (retention).

Patient’s Profile
Name: c
Age: 69
Civil Status: Married
Chief Complaint: Difficulty in urinating ptc and bloody urine few days ptc Tentative Diagnosis: Acute urinary retention prob. Secondary to BPH

History of Present Illness

a. Present History
Patient is 69 years old male retiree, a resident of PS Tagas, Tabaco City admitted at BRTTH with a chief complaint of dysuria. One week prior to consultation he had difficulty in urinating and presence of blood in the urine b. Medical History

The patient claimed that he has hypertension and diabetes mellitus type II.

Anatomy and Physiology
Prostate gland
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

Urinary Bladder 
The urinary bladder is a muscular sac for storing urine. The triangular base of the bladder, the trigone, is defined by the two ureters that deliver the urine and the one urethra that drains the urine. When empty, the bladder collapses, and folds (called rugae) from in the bladder wall. As it fills, the folds become distended and the bladder becomes spherical. The wall of the bladder consists of three layers similar to those of the urethra: the mucosa, the muscularis (here called the detrusor muscle), and the adventitia. Circular smooth muscle fibers around the urethra form the internal urethral sphincter. As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This...
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