NR 601 Week 6 UTI and BPH DP

NR 601 Week 6 UTI and BPH DP

NR 601 Week 6 UTI and BPH DP

UTI

Urinary tract infection or UTI for short can develop in both sexes but is more common in women.  Risk factors for the development of a UTI for men include being sexually active, older age, enlarged prostate, dehydration, anal sex, and kidney stones.  When it comes to risk factors for women, these include shorter urethral length compared to males, urethral meatus close proximity to the anus, sexually active, pregnancy, and dehydration (Gupta, Grigoryan, & Trautner, 2017).

UTIs are uncommon in men because of the longer length of the male urethra, antibacterial properties of prostatic fluid, and less frequent periurethral colonization, and therefore it is more concerning.  Underlaying urological problems may be the cause the UTI in males such as prostatitis, benign prostatic hypertrophy (BPH), and sexual transmitted disease (Trautner, 2014).

While treating urinary tract infections to prevent complications like urosepsis is important, there is one instance where treatment is not required unless a patient will be having a urologic procedure that can compromise the urinary tract lining (Afriyie, Asare, & Gyansa-Lurtterodt, 2014).  According to Epocrates (2018), the one instance where treatment is not recommended is with asymptomatic bacteriuria due to treatment not altering morbidity or mortality.

 

BPH

According to the American Urology Association (2018), PSA screening is no longer recommended for men under 40 years of age, men between the age of 40 – 54 years at average risk, and for men 70+ years of age or any man with less than a 10 – 15-year life expectancy.  In addition, the AUA (2018) states in their updated guidelines that routine screening intervals should be two years or more instead of annual, and that men between the age of 55 – 69 should weigh their benefits of reducing the rate of metastatic prostate cancer and prevention of prostate cancer death against the known potential harms associated with screening and treatment.

Education that would be included today if a PSA level is drawn would be that that the risk of dying from prostate cancer is only 3% over al lifetime.  I also would educate that screening tests are not perfect.  They can provide false positives and false negatives.  In addition, PSA levels can be increased for several different reasons including a diagnosis of BPH, prostatitis, and prostate massage.  Levels can also vary based on age, race, BMI and prostate size (American Urology Association, 2018).  With that said, just because a patient has an elevated PSA level, doesn’t mean that he has prostate cancer.  A thorough history has to be taken and a physical assessment including a DRE obtained before further testing for cancer are performed.

 

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References

Afriyie, D., Asare, G., & Gyansa-Lurtterodt, M., (2014).  Antimicrobial Use and Susceptibility Pattern of Uropathogens Associated with Urinary Tract Infections at the Ghana Police Hospital.  Global Journal of Pharmacology, 8(3): 306-315.  doi: 10.5829/idosi.gjp.2014.8.3.83193

American Urological Association (2018).  Early Detection of Prostate Cancer.  Retrieved from https://www.auanet.org/guidelines/prostate-cancer-early-detection-(2013-reviewed-for-currency-2018)

Gupta, K., Grigoryan, L., & Trautner, B. (2017). Urinary Tract Infection. Annals Of Internal Medicine, 167(7), ITC49-ITC64.  doi: 10.7326/AITC201710030

Trautner, B. W. (2014). New perspectives on urinary tract infection in men. JAMA Internal Medicine, 173(1), 68–70.  doi: 10.1001/jamainternmed.2014.1783