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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.