Case history
Case history #1
A 60-year-old man presents to his primary care physician with a 3-month history of increasing urinary frequency without burning and nocturia 3 times each evening. He has limited his fluid consumption and caffeine intake in the evening without much benefit. There is no personal or family history of prostate cancer. Examination demonstrates no suprapubic mass or tenderness. A rectal examination demonstrates normal rectal tone and a moderately enlarged prostate without nodules or tenderness.
Case history #2
A 72-year-old man presents with a 6-month history of weak stream, straining, and hesitancy. There is no history of prostate cancer. The physical examination demonstrates a severely enlarged prostate without nodules. There is moderate suprapubic fullness prior to voiding. A urinalysis is normal and the prostate-specific antigen level is 3.0 micrograms/L (3.0 nanograms/mL).
Other presentations
Patients may present with acute retention, bladder stones, or recurrent urinary tract infections. Some patients may present with chronic retention leading to overflow urinary incontinence. Microscopic haematuria may reflect underlying bladder or prostate cancer. In addition, underlying neurological disease and medicines affecting bladder tone may present with lower urinary tract symptoms suggestive of both overactive bladder and bladder outlet obstruction. Men with a long-standing obstruction may develop permanent changes to bladder function, leading to underactive bladder/detrusor underactivity.[2]
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