Male, 45 - difficulty with micturition

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Initial physical examination


You are a urologist in an outpatient surgery and a patient has been referred to you by a general practitioner (GP). The GP has referred a 45-year-old man to you for a non-specific micturition disorder that occurred after a cold. The patient has not observed blood in his urine, but this has not been investigated by the doctor. The patient has not yet been followed up urologically, he has not yet been treated.

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What approach will you take to obtain meaningful information about the patient that will aid his diagnosis?

You take his urine for sedimentation and cultivation, do an ultrasonic examination of the postmicturition residual, and if the above tests are negative, you recommend a change in lifestyle and a follow-up visit in 3 months. You will add uroflowmetry to the examinations performed by the GP, which will show discharge parameters at the border of obstruction and you will put him on an alpha blocker, possibly recommending an over-the-counter drug for prostate problems. You will take a complete medical history, including family history, clinical examination, laboratory tests (urea, creatinine, PSA), USG + urine sedimentation and cultivation.

This virtual patient case was created on the basis of clinical practice outside the EU and may, therefore, include an off-label practice.

I agree with playing a virtual patient case authored outside the EU. I will not draw any consequences from this case for my own or any other practice, as this case may contain unapproved use of an approved drug.

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