“I don't know exactly how to tell you my problem, Doc. I'm not old enough to have difficulty like this. And I'll tell you this much, there's no way I could discuss it with your nurse. No way!”
So began my routine office visit with a middle-aged businessman well-known in our community. Arthur (not his real name) was dignified and, as always during the business day, attired stylishly. He was proud but not haughty, with an engaging smile. Greeting me effusively, Arthur quickly became serious as he explained the reason for his visit.
He described a rather ordinary complaint of nocturia. On further investigation, though, the problem seemed somewhat different. Arthur's complaints became a bit more obtuse.
“I seem to get damp every night. Not too bad, but enough to get my pajamas and the bed wet. This began to happen shortly after my wife went out of town to care for her invalid mother.”
I talked him through the usual list of symptoms for urinary tract and prostate problems, and he seemed to have none.
“Since my wife's departure, I meet a few guys for breakfast here and there. Over coffee, I mentioned this problem and they suggested it might be … you know… from lack of …uh …activity—since I currently don't have a partner. What do you think?”
“I have never really believed that old wives' tale. Let's not come to any hurried conclusions. Do you have any other symptoms, family history of this, or consorts we should discuss?”
There was nothing out of the ordinary: no correlating symptoms or history to discuss. A physical examination and urinalysis were within expected parameters for his age, except for a very slight increase in the size of the prostate.
“It is likely that you have a low-grade prostate infection. The absence of your wife probably isn't a factor. I'm going to prescribe something that should help; check back in two weeks.”
Two weeks later he came in again. “I'm not any worse, but I'm not any better, Doc. I still have a nightly problem.”
A routine urinalysis remained negative. I suggested, and he agreed to, a prostatic massage followed by another specimen for microscopic exam and culture. We discussed adding a prostate-specific antigen test, and I recommended that he try a bedtime dose of a different medication to see if the continence could be improved. His wife was still away.
“Worth a try,” he decided. “I'll check back with you.”
I didn't hear from him after the medicine change. However, I met him on a downtown street about a month later. He was alone, so I inquired about his situation.
“Doc, my wife is back and everything is fine!”
“Hmmm, she is back and you are suddenly cured? Maybe I was wrong about that partner thing.”
“Well, maybe not totally. When she came home, she found a leak in our waterbed.”
Add another item to our list of differential diagnoses.
Dr. Roller practices family medicine in Whiteland, Indiana.