Audio_Uro_Hp_16

OFFICE VISIT

HISTORY: This 75-year-old patient was sent for evaluation and consult for his voiding difficulty. The patient is known to have BPH and having nocturia 2-3 times for the past one year. The patient also has lot of hesitancy and slow stream during the night. The patient also complains of lot of urgency and sometime urge urinary incontinence. Daytime frequency is every two hours and feels he empties the bladder completely. Last year, he had symptoms of lower urinary tract infection and was treated with the antibiotic. His PSA was high before and after the antibiotic, came back to normal. No history of diabetes. The patient is hypertensive and is on Toprol. He also takes Vytorin and Zoloft. No previous urological surgery.

LABORATORY DATA: On 02/04/2005, urinalysis was negative, BUN 12, creatinine 1.3. On 03/06/2006, PSA was 3.20.

PHYSICAL EXAMINATION: On examination, he is a well-developed, well-nourished, elderly, obese, white male, not in acute distress or pain. He is well oriented. Examination of the abdomen is obese, no organomegaly. Kidneys and bladder are not palpable. Abdomen is nontender. External genitalia, penis, testes, epididymides, and spermatic cord are normal with no evidence of inguinal lymphadenopathy or hernia. Rectal examination shows prostate 1+, 25-30 gram, firm, flat, smooth, nontender and no nodule palpated. Fingertip was not smeared with blood.

DIAGNOSIS: Benign prostate hypertrophy with bladder outlet obstruction.

PLAN: The patient is started on Flomax 0.4 mg at bedtime and advised to have PSA, urinalysis, and urine cytology. Follow up checkup in six months time.