A male reproductive organ called the prostate surrounds the urethra and lies beneath the bladder. The prostate is a gland size of a walnut and is situated between the penis and the bladder (Obaid, 2020). A fluid is secreted by the prostate, providing protection and nourishment to the sperm. As semen passes through the urethra, the prostate contracts periodically, and a milky secretion is secreted. The pH of the prostatic fluid helps sperm survivability in the acidic female reproductive tract (Mehta, 2018). It comprises fibrinolysin and clotting enzymes that enable sperm migration after ejaculation. Benign prostatic hyperplasia (BPH), also regarded as an enlarged prostate or benign prostatic hypertrophy, is a condition in which men are affected. Due to BPH, the prostate gland swells and obstructs and compresses the urethra, and urinary issues develop (Lorenzo et al., 2019). BPH affects the periurethral and transitional regions of the prostate gland and is categorized as nodular hyperplasia. The hyperplasia is usually multinodular, culminating in adenomas. BPH obstructs the bladder by distorting and compressing it. The mechanism that causes BPH is yet to be discovered (Bui et al., 2021). Androgen plays a pivotal role in gland development during adolescence, and eventually, BPH is developed. The prostate utilizes the enzyme 5-reductase to convert testosterone to dihydrotestosterone (DHT) (Marghani et al., 2022). Unlike the body’s other androgen-dependent organs, the prostate can respond to testosterone, and as a result, DHT levels remain high throughout life.
The clinical manifestations of BPH include:
PSA or prostate-specific antigen is a peptidase enzyme released by the prostate gland’s epithelial cells. It belongs to the kallikrein-associated peptidase class. PSA is alternatively termed as kallikrein-3 (KLK3) or gamma-seminoprotein. It is a glycoprotein enzyme, and in humans, it is expressed by the KLK3 gene (Papava et al., 2018). PSA is synthesized for the ejaculate to allow sperm to swim easily by liquefying semen in the seminal coagulum. It is thought to be involved in the disintegration of cervical mucus, permitting sperm to penetrate the uterus. Usually, PSA is found in relatively small amounts in the serum of healthy men; however, it gets elevated in the case of prostate diseases. It is a marker used for identifying BPH. In the case scenario, the PSA of Emilio is slightly elevated. The prostate of Emilio is moderately enlarged, but it is smooth. BPH is the most common cause of lower urinary tract symptoms (LUTS). Frequent urination, involuntary urination, urge incontinence are the storage symptoms of LUTS. The indications of voiding are urine hesitation, involuntary voiding, intermittency, incomplete emptying sensation, and so on (Dieter, 2021). Emilio complains of going to the washroom frequently but voids only small amounts of urine. These are the indications of elevated PSA. His sleep is interrupted at night due to frequent urinating. Emilio suffers from nocturia, so elevated PSA is relevant to his condition. He feels he is incontinent, which indicates an enhanced urge to urinate, indicating elevated PSA.
Laser prostatectomy is a surgical procedure for male individuals who face issues in passing urine due to an enlarged prostate gland. The laser prostatectomy process uses laser beam technology to eliminate the prostate gland’s segment (Chen et al., 2020). Urinary issues arise owing to an enlarged prostate. Laser prostatectomy helps in treating such issues. The prostate tissues are removed by laser prostatectomy that causes blockage. A surgical procedure known as transurethral resection of the prostate (TURP) is performed to treat urinary problems caused by an enlarged prostate, such as BPH. TURP is recommended for individuals having moderate to serious urinary issues (Alexander et al., 2019). Laser prostatectomy has been preferred over TURP. The patient in the case scenario is an older adult. In men with various comorbidities and older individuals, TURP has been linked to increased complication rates compared to laser prostatectomy. Healthcare professionals avoid performing TURP in older individuals who have comorbidities as chances of perioperative complications develop.
The patient in the case scenario was prescribed ciprofloxacin. Ciprofloxacin indicates that it is used to treat pneumonia and bacterial infections like those occurring in the urinary tract, lower respiratory tract infections, joint infections, plague, salmonellosis, prostatitis, and so on. It falls under the quinolone class of antibiotics and is an antibiotic agent (Kaur et al., 2022). In patients who have mixed infections, ciprofloxacin is used extensively for treating such patients. The mode of action of ciprofloxacin is that this drug inhibits DNA replication, and this drug also inhibits bacterial DNA gyrase and topoisomerase (Khan et al., 2018). This drug is most effective against inhibiting gram-negative bacteria. The drug is absorbed readily, but complete absorption is not typically achieved.
Ciprofloxacin’s contraindications include individuals who have a history of hypersensitivity to the drug or the formulation’s components. Tizanidine is used for muscle spasms, and its concurrent administration is one of the contraindications of ciprofloxacin
( Okhrits & Veliyev, 2020). Ciprofloxacin is not recommended for individuals with myasthenia gravis. It exacerbates the weakness of muscles.
When there is increased longevity, there is an increased risk of age-associated diseases. BPH is a common condition that is associated with male older individuals. The symptoms and incidence of BPH increase with ageing. The patient in the case scenario is an older adult, so it is a normal condition associated with ageing. In an ageing male individual, the blood hormone levels changes (Cesari & Arosio, 2022). The expansion of the prostate gland blocks the urethra, and urinating becomes difficult. The enlarged prostate begins to press up against the bladder, and an individual feels like urinating more frequently. Although the appropriate reason is yet to be discovered, it may be thought that the alterations in male sex hormones associated with ageing may be a potential factor for BPH. When there is a history of prostate problems in any family, then the risk of BPH is increased. Any abnormalities in the testicles also increase the risk of BPH.
References
Alexander, C. E., Scullion, M. M., Omar, M. I., Yuan, Y., Mamoulakis, C., N’Dow, J. M., … & Lam, T. B. (2019). Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD009629.pub4
Bui, T. L., Glavis-Bloom, J., Chahine, C., Mehta, R., Wolfe, T., Bhatter, P., … & Houshyar, R. (2021). Prostate minimally invasive procedures: complications and normal vs. abnormal findings on multiparametric magnetic resonance imaging (mpMRI). Abdominal Radiology, 46(9), 4388-4400. https://link.springer.com/article/10.1007/s00261-021-03097-6
Cesari, M., & Arosio, B. (2022). The ageing bladder. Pathy’s Principles and Practice of Geriatric Medicine, 2, 1153-1161. https://doi.org/10.1002/9781119484288.ch90
Chen, J. W., Lin, W. J., Lin, C. Y., Hung, C. L., Hou, C. P., Cho, C. C., … & Tang, C. Y. (2020). Automated classification of blood loss from transurethral resection of the prostate surgery videos using deep learning technique. Applied Sciences, 10(14), 4908. https://www.mdpi.com/2076-3417/10/14/4908#
Dieter, A. A. (2021). Background, Etiology, and Subtypes of Urinary Incontinence. Clinical obstetrics and gynecology, 64(2), 259-265. https://journals.lww.com/clinicalobgyn/Abstract/2021/06000/Background,_Etiology,_and_Subtypes_of_Urinary.3.aspx?context=LatestArticles
Kaur, P., Chandra, A., Tanwar, T., Sahu, S. K., & Mittal, A. (2022). Emerging quinoline and quinolone based antibiotics in the light of epidemics. Chemical Biology & Drug Design. https://doi.org/10.1111/cbdd.14025
Khan, T., Sankhe, K., Suvarna, V., Sherje, A., Patel, K., & Dravyakar, B. (2018). DNA gyrase inhibitors: Progress and synthesis of potent compounds as antibacterial agents. Biomedicine & Pharmacotherapy, 103, 923-938. https://doi.org/10.1016/j.biopha.2018.04.021
Lorenzo, G., Hughes, T. J., Dominguez-Frojan, P., Reali, A., & Gomez, H. (2019). Computer simulations suggest that prostate enlargement due to benign prostatic hyperplasia mechanically impedes prostate cancer growth. Proceedings of the National Academy of Sciences, 116(4), 1152-1161. https://doi.org/10.1073/pnas.1815735116
Marghani, B. H., Fehaid, A., Ateya, A. I., Ezz, M. A., & Saleh, R. M. (2022). Photothermal therapeutic potency of plasmonic silver nanoparticles for apoptosis and anti-angiogenesis in testosterone induced benign prostate hyperplasia in rats. Life Sciences, 291, 120240. https://doi.org/10.1016/j.lfs.2021.120240
Mehta, J. G. (2018). Laboratory Aspects of In Vitro Fertilization and Intracytoplasmic Sperm Injection. Donald School Textbook of Human Reproductive & Gynecological Endocrinology, 197. https://books.google.co.in/books?hl=en&lr=&id=GXOSDwAAQBAJ&oi=fnd&pg=PA197&dq=Fluid+is+secreted+by+the+prostate,+providing+protection+and+nourishment+to+the+sperm.+As+semen+passes+through+the+urethra,+the+prostate+contracts+periodically,+and+a+milky+secretion+is+secreted.+The+pH+of+the+prostatic+fluid+helps+sperm+survivability+in+th&ots=ihlTcToeYS&sig=e-nLpVpA-5-TB4ocgCL3LWtSnEI&redir_esc=y#v=onepage&q&f=false
Obaid, A. T. (2020). Establishing the Ordinary Narration of Men with Originally Negative Prostate Biopsies. Indian Journal of Forensic Medicine & Toxicology, 14(1). https://web.p.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=09739122&AN=148347431&h=y%2f8KRUhlVlrL8AK%2bJK7yufUIemfgdNLAM8o%2fxUOIBiWQu7qeiKFvtVR2MrDKjUL7WCsdGTaFEIuIkgcUprqYhQ%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d09739122%26AN%3d148347431
Okhrits, V. E., & Veliyev, E. I. (2020). What is the difference between levofloxacin and ofloxacin. Antibiotic Ciprofloxacin: description, indications for use and medicinal properties of the drug. Allergy. https://toreents.ru/en/allergy/chem-otlichaetsya-levofloksacin-ot-ofloksacina-antibiotik-ciprofloksacin.html
Papava, V., Didbaridze, T., Kvakhajelidze, V., Gogokhia, N., & Didbaridze, N. (2018). BACTERIAL PROSTATITIS AND PROSTATE SPECIFIC ANTIGEN LEVEL. Piretc, 1(1), 24-27. https://www.elibrary.ru/item.asp?id=42803716
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