Urology CNS - OSC Bladder

Responsible Clinician: Dr. Eleanor Vance Presenting Complaint: Haematuria and lower urinary tract symptoms. eGFR is 65. History of Presenting Complaint: Dear Dr. Jones, I am writing to you today regarding Mr. David Miller, a 68-year-old gentleman who presented with a 3-month history of intermittent painless haematuria. He also reports lower urinary tract symptoms including nocturia (2-3 times per night), frequency (every 2-3 hours), and urgency. His urinary flow is slightly reduced. He denies any bowel habit changes, including PR bleeding. His appetite is good, and he reports no weight loss. He experiences mild suprapubic discomfort, which is intermittent and not related to any specific activity. Past Medical History: Hypertension, well-controlled with medication. Previous prostatectomy for benign prostatic hyperplasia 5 years ago. Allergies: No known drug allergies. Medication: Amlodipine 5mg once daily, Tamsulosin 0.4mg once daily. Social History: Retired. Lives with his wife. Non-smoker, occasional alcohol consumption. Good performance status. No care needs. Family History: Father had prostate cancer. Examination: Chaperone present. Digital rectal examination revealed a small, firm prostate. No palpable masses. Investigations: Urinalysis showed microscopic haematuria. Flexible cystoscopy performed today, with findings of mild bladder inflammation. Consent obtained, and chaperone present. Ultrasound scan of the kidneys and bladder showed no hydronephrosis or significant abnormalities. Blood pressure 130/80, heart rate 72 bpm, oxygen saturation 98% on room air. Plan: Dear Dr. Jones, I have arranged for a repeat urine sample and a PSA test. I have discussed the findings with Mr. Miller and explained the need for further investigation. We will review the results in two weeks. I have advised him to increase his fluid intake and to avoid any irritants. I will also be discussing the possibility of further investigations such as a CT scan if the PSA is elevated. Date: 1 November 2024