SUBJECTIVE: This (XX)-year-old man is doing very well on Flomax 0.4 mg daily. He is asymptomatic and sleeps through the night. No dysuria, hematuria, frequency, urgency, or incontinence. He takes Flomax and metoprolol daily along with calcium and multivitamins. His recent PSA is 2.4.
OBJECTIVE: No rectal masses. Prostate is about 40-50 grams, rubbery, symmetrical in shape, slightly firmer along the right lateral border, but with no discrete nodularity.
ASSESSMENT: Benign prostatic hypertrophy with symptoms well controlled on Flomax 0.4 mg daily.
PLAN: He will continue to return on an annual basis; although, we will not be doing future PSA testing in view of his age.
Sample #2
SUBJECTIVE: This pleasant (XX)-year-old man is being followed status post radiation therapy for adenocarcinoma of the prostate. He has had a couple of sebaceous cysts, one of the back and one of the anterior chest wall, excised many years ago. He has noticed a small nodule in the posterior left scrotum, which he feels has doubled in size in the last six months. It has not been painful and has not drained. It has not previously been treated in any way. He has no known allergies.
OBJECTIVE: He has an obvious sebaceous cyst measuring about 1 to 1.5 cm in greatest dimension in the left posterior scrotum, which shows no erythema or evidence of infection.
ASSESSMENT: Enlarging sebaceous cyst of the left posterior scrotum, asymptomatic.
PLAN: He will be scheduled for excision of the sebaceous cyst in the next few weeks.
Sample #3
SUBJECTIVE: The patient is a (XX)-year-old gentleman who is status post laparoscopic radical prostatectomy. He returns today for followup and PSA check. PSA from two days ago was less than 0.1. We were pleased to see this result, and we do recommend that he receive PSAs in three-month increments.
In terms of continence, he is doing well. He utilizes one partial pad per day. He has done his Kegel exercises regularly, and he feels that benefited well from his biofeedback preoperatively. We have encouraged him to continue with Kegels and do expect a full recovery.
In terms of potency, he did have a bilateral nerve sparing procedure and is eligible for recovery of erections. He is interested in this, and we have therefore outlined the therapeutic benefits of medications as well as vacuum pump therapy. He is aware that patients who utilize these therapies will have a better chance recovering than those who do not.
For that reason, he will take Cialis 20 mg every three days and will use the vacuum pump multiple times a week. He does not have contraindications to do these therapeutic treatments.
ASSESSMENT:
1. Status post laparoscopic radical prostatectomy with undetectable PSA.
2. Stress incontinence.
3. Likely erectile dysfunction.
PLAN: The plan is for the patient to return in three months for a followup visit and a PSA check.
Sample #4
SUBJECTIVE: The patient is a (XX)-year-old postmenopausal female who presents for further evaluation of urinary incontinence. The patient has stress incontinence and leakage with coughing, laughing, and physical activity. Some frequency, urgency. No real prolapse noted. She was last seen a week ago, and there are no changes in the medical history. She denies any new medications, changes in medical diagnoses, or ER visits.
OBJECTIVE: On exam, pertinent pelvic findings were normal external female genitalia. Vagina was slightly atrophic. Minimal anterior and posterior compartment defects. Well-supported uterus in superior compartment. Positive cough stress test. Rectovaginal: Firm. Minimal rectocele/enterocele components.
The patient underwent simple uroflow and had a normal voiding pattern. Maximum flow rate of 40 mL/sec, average of 12, flow time of 35 seconds, and voided 450 mL with 25 mL residual. She underwent complex cystometrogram. She was filled with physiologic saline at 60 mL/min. She had her first sensation at 20 mL, normal desire to void at 425, a strong desire at 520 with a maximum cystometric capacity at 570 mL. She had a highly compliant bladder. She was asked to cough, Valsalva at each 100 mL interval. She did leak urine with this at about 200 mL. There were no contractions or bladder contractions noted during the testing. She had a urethral closure pressure profile, which was measured at 70 cm of water. Valsalva and cough leakpoint at around 80 cm of water, on average. She then underwent a voiding pressure study. She had a maximum flow rate of 40 mL/sec, average of 18 mL, flow time of 32 seconds. She voided total of 520 mL. She had a flow of peak pressure 0.3 mL/sec. Mean bladder pressure at 9 cm of water, 52 mL residual.
ASSESSMENT: Stress urinary incontinence.
PLAN: Simple, minimally invasive sling. We went over the benefits and risks of the procedure. The patient understood and accepted these risks and wanted to proceed. The patient will call us regarding when she wants the procedure done.
