The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?
A. Urge incontinence
B. Nocturia
C. Decreased force in the stream of urine
D. Urinary retention
Correct Answer: C. Decreased force in the stream of urine
Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Men with BPH are likely to report predominant symptoms of nocturia, poor stream, hesitancy, or prolonged micturition.
Option A: Lower urinary tract symptoms can be divided into storage (frequency, nocturia, urgency) and voiding symptoms (stream, straining, hesitancy, prolonged micturition) and can help establish other causes of urinary symptoms such as urinary tract infections/overactive bladder, in addition to determining the site affected (bladder vs. prostate).
Option B: Red flags help point to more sinister causes of urinary symptoms such as bladder/prostate cancer, neurology such as cauda equina, or chronic high-pressure retention (which can lead to silent renal failure). The presence of these can be established by asking about visible haematuria/bone pain/weight loss, neurology, and nocturnal enuresis/incontinence, respectively.
Option D: The development of benign prostatic hyperplasia is characterized by stromal and epithelial cell proliferation in the prostate transition zone (surrounding the urethra), this leads to compression of the urethra and the development of bladder outflow obstruction (BOO) which can result in clinical manifestations of lower urinary tract symptoms (LUTS), urinary retention or infections due to incomplete bladder emptying.
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