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Chapter 12 The reproductive systems
Case studies
Case study 1: benign prostatic hypertrophy
Peter Clarke is a recently retired teacher who lives with his wife Jane in a large semi-detached house. Peter
and Jane are now enjoying retirement; they are planning to travel to Australia in 6 months to see their new
granddaughter. They travel regularly and enjoy activities such as playing golf and hiking. Peter was a heavy
smoker until 12 months ago, when he managed to give up.
Recently, he has been experiencing recurrent urinary tract infections, which were treated with antibiotic
therapy, and on occasions he is finding it hard to pass urine; other than this he has been well. Peter is due to
see his GP in 2 days’ time as he thinks he may have another ‘water’ infection. He explains to the GP that he
has pain passing urine, and the harder he tries, the slower his flow of urine is.
The GP listens to Peter, examines him and performs serum creatinine levels and a prostatic specific
antigen (PSA) blood tests, a full blood count and makes a referral to a urologist whilst at the same time he
books an ultrasound scan (USS). A digital rectal examination (DRE) is performed that reveals an enlarged
prostate gland. Dip-stick urine reveals abnormalities that are consistent with urinary tract infection; a midstream specimen of urine is sent for analysis. The GP makes an initial diagnosis of prostatic hypertrophy; he
suspects that Peter has an enlarged prostate gland that is causing some degree of obstruction of the prostatic
urethra. Chris is prescribed a course of antibiotics.
Blood results and the USS along with the outcome of the DRE confirm the GP’s diagnosis of prostatic
hypertrophy. The consultant urologist makes arrangements for Peter to be admitted to hospital for a
transurethral resection of the prostate gland (TURP).
Peter undergoes a TURP under general anaesthetic. On return to the ward he is sleeping, has an oxygen
mask in place, an intravenous infusion is running, a urethral catheter with bladder irrigation is in situ, the
urine in the drainage bag is blood stained and there are some blood clots present. Patient-controlled analgesia
is also in progress.
Peter made an uneventful recovery and was relieved to hear that he did not have prostatic cancer. The
TURP was a success and Peter’s symptoms disappeared; Peter continues to visit his doctor on a yearly basis
to have his blood checked;this includes assessment of his PSA. Peter and Jane made the journey to Australia
to meet the new addition to the family.
Case study 2: ectopic pregnancy
Preeti is 24-year-old sexually active woman. Preeti has complained of severe left-sided lower abdominal
pain, and she has attended the accident emergency department; the pain has now become persistent. The pain
is worse when she lies down and it goes from her ‘belly’ to her shoulder. Preeti is feeling nauseous; she is
waiting for her partner Simon to arrive. Preeti has now vomited approximately 300 mL of undigested food
stuff.
Preeti informs the triage nurse that she has had light vaginal bleeding that is starting and stopping; the
bleeding is bright red. Her vital signs are unremarkable, however; she has a tachycardia of 102 beats per
minute. She looks pale and says she feels light-headed and faint.
Her last menstrual period was over 6 weeks before. The length of time between her periods was not
unusual because her menstrual cycle was irregular. When asked if she could be pregnant, she said she
thought it could not happen due to scar tissue in her fallopian tubes and uterus. A previous sexually
transmitted infection had caused the scar tissue.
A urine tests shows that Preeti was pregnant; a blood test demonstrates the presence of human
gonadotropin. A pelvic ultrasound is performed; there is no sign of a foetus in the uterus. A tentative
diagnosis of ectopic pregnancy is made and a referral to the gynaecologist is made.
Simon has arrived and Preeti is admitted to hospital, she is prescribed and given intramuscular analgesia
and an antiemetic. In order to prevent further blood loss, Preeti undergoes a laparoscopic surgery for ectopic
pregnancy; a left salpingotomy is also performed.
Preeti makes an uneventful recovery and after a night’s stay on the observation ward she is discharged
home with a follow-up appointment.