[drsue]

will go for c too........rectal examination first!

 

[drsue]

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