Audio_Uro_Hp_11

HISTORY: The above patient is a 68-year-old Hispanic male who is seen in followup for three urologic problems. The patient has been diagnosed with erectile dysfunction for many years. He used to use Caverject 20 mcg as needed for ED. He has not used medication in a while and he did not respond very well to it in the past. He is not allowed to use PDE5 inhibitors due to his cardiac condition. The patient also has nocturia three to five times per night and he uses Flomax 0.4 mg once a day. He has not tried any other medications. The patient underwent transrectal biopsy of the prostate recently due to elevated PSA.

LABORATORY DATA: Most recent PSA level was 4.2 with a free PSA of 23%.

PHYSICAL EXAMINATION: The patient was in no acute distress. The abdomen was soft and obese. The kidneys and bladder were not palpable. The penis was circumcised and meatus was normal. The testes were without masses. Digital rectal examination showed that the prostate was mild-to-moderately enlarged. A small nodule was noted at the apex at the midline.

IMPRESSION AND PLAN: The patient may want to retry Caverject 20 mcg, instructions on usage and side effects were discussed. In order to reduce his nocturia, I have suggested that he may increase his Flomax to 0.8 mg once per night. Side effects such as dizziness were discussed. I have also suggested that he should undergo repeat transrectal needle biopsy of the prostate. He will stop any medication such as aspirin, seven days prior to the biopsy. Antibiotics and other instructions prior to the biopsy were reviewed with the patient in detail.