[tkourkou]

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.

 

[tkourkou]

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...