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Discussion Starter · #1 ·
A 68-year-old man reports that after voiding his undergarments are wet because of continued urine dribbling. He has noted a decrease in urine stream pressure and needs to void 3 times during the night. He has no dysuria.
Which one of the following is the most appropriate next step in management? diagnosis?
A. Cystoscopy
B. Midstream urine for microscopy and culture
C. Rectal Examination
D. Sigmoidoscopy
E. Proctoscopy
 

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Yes. PR examination-1. can estimate the size 2. also probably knows the nature-hard, irregular surface indicates Ca rather than Benign tumor!
 

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don1

A 68-year-old man reports that after voiding his undergarments are wet because of continued urine dribbling. He has noted a decrease in urine stream pressure and needs to void 3 times during the night. He has no dysuria.
Which one of the following is the most appropriate next step in management? diagnosis?
A. Cystoscopy
B. Midstream urine for microscopy and culture
C. Rectal Examination
D. Sigmoidoscopy
E. Proctoscopy
c-cant go for the rest before rectal examination.
 

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A 68-year-old man reports that after voiding his undergarments are wet because of continued urine dribbling. He has noted a decrease in urine stream pressure and needs to void 3 times during the night. He has no dysuria.
Which one of the following is the most appropriate next step in management? diagnosis?
A. Cystoscopy
B. Midstream urine for microscopy and culture
C. Rectal Examination
D. Sigmoidoscopy
E. Proctoscopy
I would go with B

This pt has incontinence AFTER voiding, a fact which excludes overflow incontinence which is classically seen in BPH. Also, the patient experiences the need to void (watch out! no incontinence!) during the night, which points to an overreactive bladder! Overflow incontinence due to BPH is associated with bedwetting, not the nightly urge to void!

Even if we did a rectal examination first, it is not uncommon for 68yo people to have a comorbid BPH as in this patient whilst having a UTI. Thus, we would comfort ourselves that this pt has BPH and miss the UTI...

Dysuria, even though common it is not always present in UTIs.
 

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I would go with B

This pt has incontinence AFTER voiding, a fact which excludes overflow incontinence which is classically seen in BPH. Also, the patient experiences the need to void (watch out! no incontinence!) during the night, which points to an overreactive bladder! Overflow incontinence due to BPH is associated with bedwetting, not the nightly urge to void!

Even if we did a rectal examination first, it is not uncommon for 68yo people to have a comorbid BPH as in this patient whilst having a UTI. Thus, we would comfort ourselves that this pt has BPH and miss the UTI...

Dysuria, even though common it is not always present in UTIs.
Wetting his clothes after urination thats post micturition dribbling,waking up severally at night to urinate thats nocturia this shows increased frequency of urination because you have an obstruction that prevents urinating large quantities so the patients go back over and over to pass urine 'cos they have the sensation of incomplete bladder emptying,and he clearly has weak stream.

A digital rectal exam can also help in differentiating prostatitis from BPH because you expect the prostate to be tender and feel boggy with a prostatitis whereas it is firm and absence of tenderness in BPH.

with prostatitis the patient should present with fever, chills especially with acute bacterial prostatitis.

so i think its a classic case of BPH
 

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Hmmm, post-void dribbling could be a cause of prostatitis, you are right. Thus, the rectal examination should be done in order to see any tenderness...:eek:
 

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Discussion Starter · #10 ·
yeah i tot a rectal exam should be done before anything else to direct our further examinations.

sorry guys dont have the answer for this one. but rectal exam seems to be everyone's answer, so lets go with that aye?
 
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