Session 3 - Group Work

Question 1

1) Mr. Miller, a 78-year old male attends the morning surgery at the GP Practice. Mr. Miller tells you that he has been bothered over the last few months with the need to urinate more frequently - sometimes every 30 minutes to 1 hour. He is only able to plan outings when he can be sure there are toilet facilities nearby. Given this initial presentation, you wonder if Mr. Miller may be suffering from benign prostatic hyperplasia (BPH).
a) What are the typical symptoms of BPH, that you should now ask Mr. Miller to test your diagnostic hunch.

Answer 1

Do you find it difficult to start peeing?
Are you straining to pee?
Do you have a weak flow of urine?
Do you have “stop-start” peeing?
Are you having to get up in the night to pee?
Are you accidentally leaking any urine?

• finding it difficult to start peeing
• straining to pee
• having a weak flow of urine
• “stop-start” peeing
• needing to pee urgently and/or frequently
• needing to get up frequently in the night to pee
• accidentally leaking urine (urinary incontinence)
  https: //www.nhs.uk/conditions/prostate-enlargement/symptoms/

Question 2

1) Mr. Miller, a 78-year old male attends the morning surgery at the GP Practice. Mr. Miller tells you that he has been bothered over the last few months with the need to urinate more frequently - sometimes every 30 minutes to 1 hour. He is only able to plan outings when he can be sure there are toilet facilities nearby. Given this initial presentation, you wonder if Mr. Miller may be suffering from benign prostatic hyperplasia (BPH).
b) i) Where in the prostate does BPH occur?

Answer 2

Transitional zone

Question 3

1) Mr. Miller, a 78-year old male attends the morning surgery at the GP Practice. Mr. Miller tells you that he has been bothered over the last few months with the need to urinate more frequently - sometimes every 30 minutes to 1 hour. He is only able to plan outings when he can be sure there are toilet facilities nearby. Given this initial presentation, you wonder if Mr. Miller may be suffering from benign prostatic hyperplasia (BPH).
b) ii) Where in the prostate does prostate cancer develop?

Answer 3

Peripheral zone

Question 4

1) Mr. Miller, a 78-year old male attends the morning surgery at the GP Practice. Mr. Miller tells you that he has been bothered over the last few months with the need to urinate more frequently - sometimes every 30 minutes to 1 hour. He is only able to plan outings when he can be sure there are toilet facilities nearby. Given this initial presentation, you wonder if Mr. Miller may be suffering from benign prostatic hyperplasia (BPH).
b) Where in the prostate does BPH occur? Where in the prostate does prostate cancer develop?
iii) How does that affect what you expect to find on physical examination of Mr. Miller?

Answer 4

Prostate cancer develops in the peripheral zone, so will be felt on a DRE.

BPH develops in the transitional zone so will not.

Question 5

1) Mr. Miller, a 78-year old male attends the morning surgery at the GP Practice. Mr. Miller tells you that he has been bothered over the last few months with the need to urinate more frequently - sometimes every 30 minutes to 1 hour. He is only able to plan outings when he can be sure there are toilet facilities nearby. Given this initial presentation, you wonder if Mr. Miller may be suffering from benign prostatic hyperplasia (BPH).
c) What further questions do you need to ask to learn more about his urinary status and to rule out other causes of his urinary symptoms?

Answer 5

?????
- Dysuria 
- Frequency
- Urgency
- Nocturia
- Haematuria 
- Hesitancy and terminal dribbling
- Poor urinary stream 
- Incontinence
- Fever/rigors – suggestive of infection/urosepsis
- Nausea/vomiting – often associated with pyelonephritis 
Pain