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Difficulty Urinating - Coggle Diagram

- - - - Unlikely: No relevant history of medication use.
    - - Eliminated: No systemic symptoms like lethargy or cold intolerance; unrelated to LUTS.
    - - Unlikely: Normal random blood glucose (110 mg/dL).
    - - Supported: UTI present, potentially caused by bacterial agents like E. coli (most common in UTIs).
  - - - Neurogenic bladder
        
        Eliminated: No history of neurological conditions or symptoms like urinary retention associated with neural deficits.
      - Bladder Diverticulum
        
        Unlikely: No imaging evidence of diverticulum on ultrasound.
      - Cystitis
        
        Supported: Dysuria and findings of UTI in urinalysis (positive leukocyte esterase, nitrites, and bacteria). Likely a complication secondary to BPH.
      - Bladder Stone
        
        Eliminated: No evidence of stones on ultrasound; symptoms are gradual, not sudden.
      - Bladder Cancer
        
        Unlikely: No gross hematuria or imaging findings suggestive of malignancy.
    - - Stricture
        
        No history of trauma, catheterization, or prior surgery; no evidence of weak urinary stream due to mechanical stricture.
      - Urethral Calculi
        
        Eliminated: No radiological evidence of stones in the urethra, no sudden-onset pain during urination.
      - Urehtritis
        
        Unlikely: No urethral discharge or sexual history suggesting sexually transmitted infections.
      - Foreign Object
        
        Eliminated: No history of trauma or foreign body insertion.
      - Trauma
        
        Eliminated: No history of trauma or foreign body insertion.
      - Urethral Sphincter Dysfunction
        
        No history of trauma, catheterization, or prior surgery; no evidence of weak urinary stream due to mechanical stricture.
    - - Prostatitis
        
        Eliminated: No systemic symptoms such as fever or chills; no tenderness on digital rectal examination.
      - BPH
        
        Learning Issues
        
        Risk Factors
        
        Diabetes & antidiabetic medications
        
        Insulin
        
        Localized inflammation
        
        Genetic predisposition
        
        Obesity
        
        Dietary factors
        
        alcohol
        
        supplemental vitamin C
        
        Caffeine
        
        Metabolic syndrome
        
        Pathophysiology
        
        Increase in Hormones (DHT, Testosterone, Estrogen)
        
        Stromal and Epithelial Proliferation
        
        Old Age (>50 Years Old)
        
        1 more item...
        
        Inflammation
        
        Prostate Enlargement
        
        2 more items...
        
        Prevention & Education
        
        Lifestyle modification
        
        Dietary changes
        
        Prognosis & Complications
        
        Prognosis
        
        Manageable with early intervention
        
        severe untreated cases may lead to irreversible bladder and kidney damage
        
        Complications
        
        Hematuria
        
        Incomplete Bladder Emptying
        
        Hydronephrosis
        
        Postoperative Incontinence
        
        Renal Failure
        
        Decompensated Bladder
        
        Bladder Calculi
        
        Chronic Urinary Retention
        
        Acute Urinary Retention
        
        Recurrent UTIs
        
        Treatment & Management
        
        Medication
        
        α1-Blockers:
        Tamsulosin (Mengurangi tonus otot polos di leher kandung kemih dan prostat).
        
        5α-Reductase Inhibitors:
        Menghambat konversi testosteron menjadi dihidrotestosteron (DHT),
        mengurangi ukuran prostat, dan memperlambat progresi BPH
        
        Surgery
        
        Transurethral Resection of the Prostate (TURP)
        
        Conservative
        
        Bladder retraining
        
        No water before sleep
      - Prostate cancer
        
        Mildly elevated PSA (4.6 ng/mL), smooth prostate contour on ultrasound, no hard nodules on DRE.
- - - - A palpable mass in the 11–1 o’clock position
        
        well-defined borders, smooth surface
        
        palpable median sulcus.
        
        firm yet elastic consistency
      - Absence of nodules or tenderness (Rules out prostatitis & prostate cancer which are commonly associated with hard nodules, tenderness, or irregular consistency.)
  - - - PSA Level: 4.6 ng/mL (above the normal range of <4 ng/mL).
        
        Note: PSA can be elevated in BPH due to increased prostate volume and cellular activity, but this value does not strongly suggest malignancy as it is only mildly elevated.
    - - Blood (+1): Suggests mild hematuria
        
        which can occur due to bladder irritation from incomplete emptying or pressure effects from the enlarged prostate.
      - Nitrites and leukocyte esterase positive, leukocytes (20–30/LPB), and bacteria present
        
        Indicate a urinary tract infection (UTI), which is a common complication in patients with urinary retention from BPH.
    - - Prostate Volume: Approximately 60 mL (normal range: 20–30 mL).
      - Residual Urine: Post-void residual volume of 50 mL
        
        Indicates incomplete bladder emptying, a hallmark of lower urinary tract symptoms (LUTS) commonly associated with BPH.
      - Prostate Contour: Smooth, without nodules or suspicious lesions.
        
        Supports benign enlargement rather than malignancy.