Mr. P is 77 yrs old and is having urinary problems. He urinates more frequently than he did when he was younger, but he still can’t seem to fully empty his bladder. He has to get up several times at night to use the bathroom and it is exhausting him!
Physical exam: consider what exam would be helpful in determining his diagnosis
Labs: urinalysis is normal
Assessment: Urinary obstruction due to ______?
Instructions
Answer the following questions based on the scenario and article above and save your responses in a Microsoft Word document. Provide a scholarly resource in APA format to support your answers.
- Trace the flow of urine from the collecting duct to the urethral meatus.
- Based on your knowledge of the male urinary tract, what normal organ is most likely obstructing the urinary outflow?
- Based on the anatomic location of this structure, how can this structure be examined?
- Based on your knowledge of anatomical differences, why are women more likely than men to get urinary tract infections?
- Predict the consequences of the inability to empty the bladder.
- Flow of urine from the collecting duct to the urethral meatus: The flow of urine in the urinary system starts with the kidneys, where blood is filtered to form urine. The urine is then collected in the renal pelvis and travels through the ureters, which are muscular tubes that connect the kidneys to the urinary bladder. Once in the bladder, urine is stored until it is ready to be expelled from the body. During urination, the urine flows from the bladder through the urethra, a tube that extends from the bladder to the external urethral meatus, which is the external opening through which urine is expelled from the body.
- Most likely organ obstructing urinary outflow: Based on the scenario described, the most likely organ obstructing urinary outflow in Mr. P is the prostate gland. The prostate gland is a male reproductive organ located just below the bladder and surrounds the urethra. It plays a role in producing semen and helps control the flow of urine by relaxing and contracting during urination.
- Examination of the prostate gland: To examine the prostate gland, a digital rectal examination (DRE) would be helpful. During this procedure, a healthcare professional inserts a lubricated, gloved finger into the rectum to palpate the prostate gland. The size, shape, and consistency of the prostate can be assessed during the DRE. Additionally, other imaging studies like transrectal ultrasound may also be used to further evaluate the prostate and its obstruction.
- Women’s higher susceptibility to urinary tract infections (UTIs): Women are more likely than men to get urinary tract infections due to anatomical differences. The female urethra is shorter than the male urethra, which makes it easier for bacteria to travel up the urinary tract and reach the bladder. The urethra’s proximity to the anus in women also increases the risk of bacterial contamination from the gastrointestinal tract. Additionally, hormonal changes during the menstrual cycle and menopause can affect the pH balance of the vagina and make it more susceptible to infection.
Scholarly resource: Hooton, T. M. (2012). Clinical practice. Uncomplicated urinary tract infection. New England Journal of Medicine, 366(11), 1028-1037.
- Consequences of the inability to empty the bladder: The inability to fully empty the bladder, also known as urinary retention, can lead to several consequences:
a. Increased urinary frequency: The bladder will signal the need to urinate more frequently since it cannot hold as much urine as it should.
b. Nocturia: Frequent nighttime awakenings to urinate, which can disrupt sleep patterns and lead to fatigue and exhaustion, as described in Mr. P’s case.
c. Urinary tract infections (UTIs): Urine that remains in the bladder for extended periods can become a breeding ground for bacteria, leading to an increased risk of UTIs.
d. Bladder distension: Over time, the bladder may become distended and lose its ability to contract properly, further exacerbating the retention problem.
e. Hydronephrosis: In severe cases, the inability to empty the bladder can cause urine to back up into the kidneys, leading to kidney swelling and potential damage.
f. Urinary incontinence: In some cases, urinary retention can cause overflow incontinence, where small amounts of urine leak uncontrollably.
It is important for Mr. P to seek medical attention promptly to diagnose the underlying cause of his urinary obstruction and receive appropriate treatment to alleviate his symptoms and prevent potential complications.