Urinary incontinence Quiz: Ace Your Exams

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A 75 year-old African-American male comes to the office because of continuous dribbling of urine which began one month ago. In addition, the patient endorses difficulty initiating and maintaining a urinary stream. Past medical records indicate that he has hypertension and type 2 diabetes mellitus. The patient has a 40-pack-year smoking history. His temperature is 37.0°C (98.6°F), blood pressure is 150/86 mmHg, pulse is 70/min, and respirations are 15/min. Cardiac, pulmonary, and abdominal examinations are non-contributory. Digital rectal exam reveals an enlarged, symmetrical, and smooth prostate. Laboratory study results are as follows:  
 
 Laboratory value  Result 
 Glucose  118 mg/dL 
 HbA1c  6.9% 
 Prostate-specific antigen (PSA)*  3.6 ng/ml 
*Normal PSA < 4.0 ng/ml

Which of the following is the most likely cause of the patient’s urinary symptoms?

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