“I have been experiencing extreme pain in my lower abdomen before, during, and after urinating. When I urinate, my stream stops and starts, it feels like I can’t seem to completely empty my bladder and there is dribbling when I finish urinating”.
D.S. is an 82-year-old white male patient who has come to the clinic accompanied by his son aged 47 years old. His chief complaint is extreme pain and discomfort in the lower abdomen and the urethra before, during, and after urination. According to D.S., he has trouble starting urination with a delay that is characterized by pain. He is also unable to stop urination completely as he usually has some urine still leaking out of the urethra after urination.
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The patient denies a history of benign prostatic hyperplasia. He has type 2 diabetes and high blood pressure which he is currently managing effectively using medications. As reported by D.S., although he started to experience the named symptoms about two months ago, he has been reluctant to seek medication because he thought that they will disappear on their own. He lasted visited a doctor for a physical exam three years ago.
Location: Lower abdomen and the urethra.
Quality: Sharp pain.
Quantity or severity: Extreme pain. 8/10 on the pain scale.
Timing: Intermittent.
Setting: Before, during, and after urination.
Aggravating or relieving factors: Urge to urinate aggravates the pain. The pain is relieved about 10 minutes after urination.
Associated manifestations: Dribbling or leaking urine after urination due to inability to stop the urine completely.
III. Past medical history (PHx)
D.S. cannot trace his childhood medical records. Again, he is unable to remember whether he had any childhood illnesses or not.
The patient does not know whether he received all his childhood medications or not. He lastly received tetanus booster 5 years ago. His last influenza vaccination occurred 3 months ago with his adulthood medical records indicating that he received High-dose inactivated influenza vaccine (HD-IIV). He has been fully vaccinated against COVID-19. He has taken two doses of Oxford/AstraZeneca vaccine 02/01/2022 and 01/03/2022.
D.S.’s son indicates that is father was hospitalized three years ago due to medical complications caused by both type 2 diabetes and high blood pressure. He was treated and discharged. Since then, D.S. has been managing these two conditions effectively at home without any other hospitalizations.
D.S. denies undergoing any surgery or medical operations before.
Denies food or drug allergies.
500 mg of metformin taken orally once a day to manage type 2 diabetes
100 mg of atenolol taken orally once a day to manage high blood pressure
D.S. uses meditation as a complementary treatment for his health problems.
D.S.’s father died of ischemic attack 20 years ago at the age of 87 years. His mother died 32 years ago at the age of 75 years. His paternal and maternal grandparents died long time ago when he was still a young adult. He cannot remember their causes of death. D.S. is married to his lovely wife aged 74 years with whom they have stayed for more than 45 years. He has four children: two sons and two daughters. All his children are currently married and are staying with their families. He does not have any reports of his children and grandchildren being diagnosed with any serious medical conditions.
D.S. is a retired engineer. He has a construction consultancy firm which is currently managed by his children. He is unable to manage the firm due to advanced age. D.S. lives with his wife, house help, and a gardener at home. He and his wife rarely leave their compound. Besides, they do not engage in any physical activities at home and in the community. D.S. does not consume alcohol or cigarettes. He denies using illicit substances like cocaine and heroin. He does not consume processed foods, red meat, or beverages. His typical diet comprises green leafy vegetables, boiled bananas, porridge, and fruits.