What are the next steps for a patient with nocturnal enuresis and post-micturition dribbling, with normal blood results and a family history of prostate cancer, pending renal ultrasound results?

From the Guidelines

For a patient with nocturnal enuresis and post-micturition dribbling, with normal blood results and a family history of prostate cancer, the next steps should include a comprehensive urological evaluation while awaiting renal ultrasound results. I recommend scheduling an appointment with a urologist for a thorough assessment, including a digital rectal examination to evaluate prostate size and consistency, and possibly a prostate-specific antigen (PSA) test given the family history of prostate cancer, as suggested by the AUA guideline on management of benign prostatic hyperplasia 1. In the meantime, behavioral modifications can be implemented, such as:

• Fluid restriction in the evening (particularly avoiding caffeine and alcohol)
• Scheduled voiding before bedtime
• Double-voiding techniques (urinating, waiting a few moments, then trying again) to reduce post-micturition dribbling For nocturnal enuresis, desmopressin (DDAVP) at 0.2-0.4 mg orally at bedtime might be considered if there are no contraindications, though this should be discussed with the urologist, as supported by the evaluation of and treatment for monosymptomatic enuresis study 1. Pelvic floor exercises (Kegel exercises) performed daily can help strengthen urinary control muscles and reduce dribbling. These recommendations address the immediate symptoms while the underlying cause is being investigated. The nocturnal enuresis may be related to detrusor overactivity, reduced bladder capacity, or increased urine production at night, while post-micturition dribbling often relates to urethral issues or prostate enlargement, which is why the comprehensive urological workup is essential, as outlined in the AUA guideline on management of benign prostatic hyperplasia 1. It is also important to consider the patient's family history of prostate cancer, as discussed in the American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer 1.

From the FDA Drug Label

HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use finasteride tablets USP safely and effectively. FINASTERIDE Tablets USP, 5 mg for oral use Initial U. S. Approval: 1992 INDICATIONS AND USAGE Finasteride tablets, are a 5α-reductase inhibitor, indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to (1. 1): • Improve symptoms • Reduce the risk of acute urinary retention • Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy

The next steps for a patient with nocturnal enuresis and post-micturition dribbling, with normal blood results and a family history of prostate cancer, pending renal ultrasound results, include:

• Waiting for the renal ultrasound results to assess prostate volume and rule out any urinary retention or other abnormalities
• Reviewing the results of the PSA test, renal function, and urine test to determine if further investigation or treatment is needed
• Considering the patient's symptoms and medical history, including the family history of prostate cancer, to determine the best course of action
• Possibly initiating treatment with a 5-alpha-reductase inhibitor, such as finasteride, if the patient is diagnosed with benign prostatic hyperplasia (BPH) 2 Key considerations include:
• The patient's symptoms of nocturnal enuresis and post-micturition dribbling
• The family history of prostate cancer
• The need to rule out other urological conditions that may cause similar symptoms
• The potential risks and benefits of treatment with a 5-alpha-reductase inhibitor, such as finasteride 2

From the Research

Next Steps for Patient with Nocturnal Enuresis and Post-Micturition Dribbling

• The patient's symptoms of nocturnal enuresis and post-micturition dribbling, combined with a family history of prostate cancer, warrant further investigation for possible prostate enlargement 3, 4.
• Normal blood results do not rule out the possibility of prostate issues, and the pending renal ultrasound results will provide more information on prostate volume and post-void residual urine volume 5, 6.
• The patient's symptoms and family history suggest the need for a comprehensive assessment, including prostate-specific antigen (PSA) testing, renal function tests, and urine analysis 4, 7.
• The results of the renal ultrasound and other investigations will guide the next steps in management, which may include pharmacotherapy, surgery, or minimally invasive procedures for benign prostatic hyperplasia (BPH) or other conditions 3, 7.
• The patient's quality of life and potential complications, such as bladder damage or acute urinary retention, should be considered in the management plan 7.

Considerations for Prostate Enlargement

• Prostate enlargement can cause lower urinary tract symptoms (LUTS), including nocturnal enuresis, post-micturition dribbling, and urinary frequency or urgency 3, 4.
• The patient's family history of prostate cancer increases the risk of prostate issues, and PSA testing is essential for early detection and monitoring 4.
• The results of the renal ultrasound and PSA testing will help determine the presence and severity of prostate enlargement and guide further management 5, 6.

Importance of Renal Ultrasound Results

• The renal ultrasound results will provide valuable information on prostate volume, post-void residual urine volume, and potential renal complications 5, 6.
• The results will help identify any obstructive uropathy or other renal issues that may be contributing to the patient's symptoms 6.
• The combination of renal ultrasound, PSA testing, and clinical assessment will enable a comprehensive diagnosis and management plan for the patient's condition 4, 7.