Audio_Uro_Hp_15

OFFICE VISIT

HISTORY: This 73-year-old patient was sent for evaluation and consultation for his carcinoma of the kidney. The patient had left radical nephrectomy in August 2006 at a county medical center for renal cell carcinoma. The patient is here for checkup. The patient is diabetic and is controlled on diet. He has hypertension and takes Cartia, lisinopril, metoprolol and Zoloft. The patient has no voiding difficulty. Nocturia twice and daytime frequency is 2-3 times. Claims to have a good urinary stream. No dysuria. He feels that he empties the bladder completely. No urinary tract infection or gross hematuria. The patient also has right hip replacement in November 2004.

PHYSICAL EXAMINATION: On examination, he is a well-developed, well-nourished, elderly, white male who walks with a walker. He is not in pain or distress and he is well oriented. Examination of the abdomen reveals no organomegaly. Kidneys and bladder are not palpable. Abdomen is nontender. External genitalia, penis, testes, epididymis, and spermatic cord are normal with no evidence of inguinal lymphadenopathy or hernia. Rectal examination shows prostate 1+, 20-25 grams, firm, flat, smooth, nontender and no nodule palpated.

DIAGNOSES:
1. Carcinoma of the left kidney.
2. Benign prostatic hypertrophy.

PLAN: The patient is advised to have urinalysis, BUN, creatinine, and PSA and obtain the records from the county hospital, especially pathology report and operative report. Follow up checkup in six months time.