NRNP 6531 Case Study #3
Week 7 – Genitourinary: Urinary Frequency and Nocturia
Patient Information
Name: RB
Age: 67
Sex: Male
Occupation: Retired Electrician
Chief Complaint
“I feel like I’m constantly running to the bathroom, especially at night.”
History of Present Illness (HPI)
RB is a 67-year-old White male who presents with gradually worsening lower urinary tract symptoms over the past 18 months. He reports increased urinary frequency, urgency, weak urinary stream, hesitancy, intermittent stream, and a sensation of incomplete bladder emptying.
He awakens three to four times each night to urinate and states this is affecting his sleep and daytime energy level.
He denies dysuria, fever, chills, flank pain, gross hematuria, urinary incontinence, penile discharge, or pelvic pain.
He occasionally strains to initiate urination and reports dribbling after voiding.
He drinks two cups of coffee every morning and one diet soda most afternoons. He limits fluids after dinner but continues to experience nocturia.
He denies recent urinary tract infections.
His symptoms have gradually worsened and are beginning to interfere with travel and social activities.
Past Medical History
Hypertension
Hyperlipidemia
Type 2 diabetes mellitus
Erectile dysfunction
Past Surgical History
Appendectomy age 24
Medications
Lisinopril 20 mg daily
Atorvastatin 20 mg nightly
Metformin 1000 mg twice daily
Sildenafil 50 mg as needed
Daily multivitamin
Allergies
No known drug allergies
Family History
Father
Benign prostatic hyperplasia
Mother
Hypertension
Brother
Prostate cancer diagnosed age 71 Social History Lives with spouse.
Retired.
Former smoker (25 pack years; quit 12 years ago).
Drinks one to two beers on weekends.
Walks several days each week.
Social Determinants of Health
Education: High school graduate
Employment: Retired
Housing: Stable housing
Transportation: Reliable transportation
Healthcare Access: Has Medicare but delayed evaluation because he believed symptoms were a normal part of aging.
Review of Systems
General
Denies fever, chills, fatigue, or unintended weight loss.
Genitourinary
Urinary frequency
Nocturia
Weak stream
Hesitancy
Postvoid dribbling
Incomplete bladder emptying
Denies dysuria
Denies hematuria
Denies flank pain
Cardiovascular
Denies chest pain.
Respiratory
Denies cough.
Neurologic
Denies lower extremity weakness.
Vital Signs
BP: 138/82 mmHg
HR: 72 bpm
RR: 16
Temp: 98.3°F
Height: 5 ft 10 in
Weight: 212 lb
BMI: 30.4
Physical Examination
General
Alert.
Well appearing.
No acute distress.
Abdomen
Soft.
Nontender.
No suprapubic tenderness.
No palpable bladder distention.
No CVA tenderness.
Genitourinary
External genitalia normal.
No penile lesions.
No urethral discharge.
Digital Rectal Examination Prostate is symmetrically enlarged.
Smooth.
Rubbery consistency.
Approximately 45 grams.
No nodules.
No tenderness.
Normal rectal tone.
Neurologic Normal lower extremity strength.
Normal sensation.
Diagnostic Data
International Prostate Symptom Score (IPSS)
19
Moderate symptoms
Urinalysis
Negative
No leukocytes
No nitrites
No blood
PSA
2.4 ng/mL
Serum Creatinine
0.9 mg/dL
Postvoid Residual (Bladder Scan)
95 mL
Clinical Judgment Question
This patient presents with classic lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Explain why BPH is the most likely diagnosis and identify which clinical findings would instead raise concern for prostate cancer, urinary tract infection, or urinary retention requiring urgent evaluation or referral.