Sample Type / Medical Specialty: Discharge Summary
Sample Name: Urology Discharge Summary
Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction.
(Medical Transcription Sample Report)
Cystourethroscopy and transurethral resection of prostate.COMPLICATIONS:
This 67-year old Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction. Physical examination revealed normal heart and lungs. Abdomen was negative for abnormal findings. LABORATORY DATA:
BUN 19 and creatinine 1.1. Blood group was A, Rh positive, Hemoglobin 13, Hematocrit 32.1, Prothrombin time 12.6 seconds, PTT 37.1. Discharge hemoglobin 11.4, and hematocrit 33.3. Chest x-ray calcified old granulomatous disease, otherwise normal. EKG was normal. COURSE IN THE HOSPITAL:
The patient had a cysto and TUR of the prostate. Postoperative course was uncomplicated. The pathology report is pending at the time of dictation. He is being discharged in satisfactory condition with a good urinary stream, minimal hematuria, and on Bactrim DS one a day for ten days with a standard postprostatic surgery instruction sheet. DISCHARGE DIAGNOSIS:
Enlarged prostate with benign bladder neck obstruction.
To be followed in my office in one week and by Dr. ABC next available as an outpatient.
discharge summary, tur, bun, cystourethroscopy, difficulty voiding, bladder neck obstruction, creatinine, cysto, enlarged prostate, transurethral resection of prostate, urinary stream, bladder neck, neck obstruction, prostate,
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