Urology Study

PRESENT COMPLAINT

Difficulty with his bladder.

HISTORY OF PRESENT ILLNESS

This 68-year-old gentleman was first seen with a problem of bladder difficulty.  He was noticing he was having severe urgency to the point that he was wearing Depends pads at night, even sometimes needing them during the day if he was going out.  Says sometimes his stream is fairly strong, sometimes it just barely dribbles out.  Says he voids about 15 times during the day, goes at least every 2 hours at night; most of the time it is more than that, but has to wear a pad to bed at night because he has a good deal of leakage and enuresis as well.  He denies dysuria.  He states that back in 1970, he had a colostomy and an abdominoperineal for carcinoma of the colon.  It was localized and he did not require any therapy afterwards, and as far as they are concerned, currently he is clinically cured.  About a year following that, he still was having a lot of difficulty with his bladder, and he did undergo a TUR of the prostate, apparently for benign disease.  Said his bladder worked extremely well for a long period of time but has been only noticing the extremely severe problems since July of this year.

When seen in the office, I could palpate his bladder.  I did check him for a postvoiding residual, and it was just about
1000 cc.

PAST MEDICAL HISTORY

His past medical history is otherwise one of good general health.  He had a birth injury to his right arm.  Has had no difficulty with headaches, blurred vision, dizzy spells, no hypertension.  Cardiac status as far as he knows is excellent.  Surgery includes cholecystectomy, and also some surgery done on his hand as a child, and a remote appendectomy.

ALLERGIES

ALLERGIES TO SULFA AND KEFLEX.

MEDICATION TAKEN

Did have seizures in childhood.  He uses Dilantin but somewhat on an erratic basis, as little as skipping days to as many as 3 a day.

His colostomy function well without any difficulty.  He handles this quite well without problems.  There has been no nausea, vomiting, or weight loss.

PHYSICAL EXAMINATION

VITAL SIGNS:  On physical examination, his blood pressure is 140/84, pulse 88 and regular, respirations 18.

ABDOMEN:  He has a healthy-appearing colostomy.  On abdominal percussion, I could originally percuss his bladder up just below the umbilicus.

RECTAL:  Rectal not possible.

IMPRESSION

Impression is that of recurrent bladder neck obstruction in a gentleman with an abdominoperineal, with high residual urines.

FOOTNOTE

Line 25 (Page 1).  Really was deleted.

Line 28 (Page 1).  Since the last July of this year was edited to Since July of this year.

Line 35 (Page 1).  Past history of medical was edited to past medical history.