Malignant neoplasm of prostate Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS) Bladder neck obstruction Incomplete bladder emptying Unspecified essential hypertension
 
Name:  ___             Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   M
 
Service: UROLOGY
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___.
 
Chief Complaint:
Prostate cancer, obstructive symptoms
 
Major Surgical or Invasive Procedure:
TURP, bipolar

 
History of Present Illness:
___, who was seen in preparation today for his upcoming 
TUR
prostate scheduled for ___.  His TUR prostate is part of his
ongoing treatment program set up for his stage T3A and B
adenocarcinoma of the prostate, associated with high residual
urine volumes in the 400s.  He has been on Lupron therapy since
___ and his residual urine volume today is 234 mL.  Indeed
rectal exam reveals a tumor outside the capsule.  A history and
physical was done and I went over the operation with the patient
and his wife including the fact that part of his obstructive
problem is lack of dynamic voiding due to scarring and
infiltration of the tumor into the bladder neck area.  
Therefore,
removing the obstruction may not completely free up his voiding
such that he may still have an elevated residual urine volume,
but it should be better than it is today.  In addition, I will
leave a small amount of extra tissue at the apex to assure
against incontinence as the entire prostatic area may be 
somewhat
rigid and removing all of the prostatic tissue could result in
incontinence.  Putting all this together, the operation will be
done carefully to open it up as much as possible without any
incontinence problems.
 
Past Medical History:
- history of low-grade colitis diagnosed on colonoscopy at
___ in ___, started on Canasa suppository
and was on them for about a month, but has not used them in over
___ years.  He saw occasional trace blood in the stool, but
nothing regularly.  He has not had a colonoscopy since ___
- hypertension.

 
Social History:
___
Family History:
Father had coronary disease and his mother had
___ disease.  Paternal uncle had stomach cancer and his
maternal grandfather had stomach cancer.

 
Physical Exam:
AFVSS
NAD, pleasant and conversive
non-labored breathing
soft, non-tender, non-distended
3-way catheter in place, draining clear yellow urine
WWP
grossly non-focal
 
Brief Hospital Course:
Mr. ___ was admitted to Dr. ___ service after 
bipolar transurethral resection of prostate. No concerning 
intraoperative events occurred; please see dictated operative 
note for details. He patient received ___ antibiotic 
prophylaxis. The patient's postoperative course was 
uncomplicated. He received intravenous antibiotics and 
continuous bladder irrigation overnight. On POD1 the CBI was 
discontinued and Foley catheter was kept in place with plans for 
follow up the following week in clinic for vodiding trial. His 
urine was clear and and without clots. He remained afebrile 
throughout his hospital stay.  At discharge, the patient had 
pain well controlled with oral pain medications, was tolerating 
regular diet, ambulating without assistance.  He was given 
pyridium and oral pain medications on discharge and a course of 
antibiotics along with explicit instructions to follow up in 
clinic with Dr. ___.
 
Medications on Admission:
 Lisinopril 20 mg daily, hydrochlorothiazide 12.5
daily, Flomax 0.4 mg b.i.d.  

 
Discharge Medications:
1. bacitracin zinc 500 unit/gram Ointment Sig: One (1) Appl 
Topical TID (3 times a day) as needed for penile irritation: 
apply to tip of penis for pain relief.
Disp:*1 tube* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*
3. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
hours) as needed for pain, fever>100.
Disp:*60 Tablet(s)* Refills:*0*
4. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 10 
days: to be taken until catheter removed.
Disp:*20 Tablet(s)* Refills:*0*
5. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every ___ hours 
as needed for pain: for pain not relieved with tylenol or 
ibuprofen.
Disp:*20 Tablet(s)* Refills:*0*

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Prostate cancer, obstructive symptoms

 
Discharge Condition:
Stable, Good
A/Ox3
Functionally independent

 
Discharge Instructions:
INSTRUCTIONS:
-Do not lift anything heavier than a phone book (10 pounds) or 
drive until you are seen by your Urologist in follow-up

-You may continue to periodically see small amounts of blood in 
your urine--this is normal and will gradually improve

MEDICATIONS:
      -Resume all of your pre-admission medications, except HOLD 
aspirin until you see your urologist in followup AND your foley 
has been removed (if not already done)

      -Complete a course of antibiotics (Ciprofloxacin)

      -You will be discharged home with a medication called 
PYRIDIUM that will help with the "burning" pain you may 
experience when voiding. This medication may turn your urine
bright orange.

      -Colace has been prescribed to avoid post surgical 
constipation and constipation related to narcotic pain 
medication. Discontinue if loose stool or diarrhea develops. 
Colace is a stool softener, NOT a laxative

-Do not eat constipating foods for ___ weeks, drink plenty of 
fluids to keep hydrated

-No vigorous physical activity or sports for 4 weeks or until 
otherwise advised

-Tylenol should be your first line pain medication, a narcotic 
pain medication has been prescribed for breakthrough pain >4. 
Replace Tylenol with narcotic pain medication.

-Max daily Tylenol (acetaminophen) dose is 4 grams from ALL 
sources, note that narcotic pain medication also contains 
Tylenol

-Do not drive or drink alcohol while taking narcotics and do not 
operate dangerous machinery. Also, if the Foley catheter and Leg 
Bag are in place--Do NOT drive (you may be a passenger).
 
Followup Instructions:
___

{'Prostate cancer': ['Malignant neoplasm of prostate'], 'obstructive symptoms': ['Malignant neoplasm of prostate', 'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'], 'high residual urine volumes': ['Malignant neoplasm of prostate', 'Incomplete bladder emptying'], 'tumor outside the capsule': ['Malignant neoplasm of prostate'], 'scarring and infiltration of the tumor into the bladder neck area': ['Malignant neoplasm of prostate', 'Bladder neck obstruction'], 'low-grade colitis': [], 'hypertension': ['Unspecified essential hypertension']}