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Symposium articles

Prompt diagnosis of epididymo-orchitis can prevent complications

25 Apr 2022Paid-up subscribers

Epididymo-orchitis is an inflammation of the testis and epididymis, generally of infectious origin. In young men epididymo-orchitis is most often associated with sexually transmitted infections. In those aged over 35 the causative pathogens are more likely to be non-sexually transmitted coliform organisms associated with urinary tract infections. Other causes include viral infections such as mumps in immunocompromised, non-immunised or prepubescent males, local trauma, and medication such as amiodarone. 

Improving the early detection and management of prostate cancer

25 Apr 2022Paid-up subscribers

Prostate cancer is the most common cancer in men in the UK. In men with possible symptoms of prostate cancer, an assessment of LUTS, relevant risk factors and past medical history is essential. NICE recommends performing a DRE; this will give an impression of prostate size. If the prostate feels malignant on DRE this should trigger a fast-track referral to secondary care, via a suspected cancer pathway referral even if the PSA is normal. A PSA test should also be offered to men with LUTS or an abnormal DRE.

GPs should have a high index of suspicion for testicular cancer

22 Apr 2021Paid-up subscribers

Most men with testicular cancer present with a lump that they have identified in their scrotum. Although the scrotal swelling is usually painless, pain is the first symptom in around 20% of patients, typically a dull or dragging ache in the testicle or a heaviness in the scrotum. NICE recommends that all men who have a non-painful enlargement or change in shape or texture of their testis should be referred urgently to urology using the two-week wait pathway. In men who have unexplained or persistent testicular symptoms, an urgent direct access testicular ultrasound scan should be requested. 

Thorough assessment key to management of varicocele

22 Apr 2021Paid-up subscribers

Varicoceles are usually asymptomatic but some patients may present with a scrotal swelling or pain. The patient should be examined in both the standing and supine positions, with and without a Valsalva manoeuvre. Patients may also present with primary or secondary infertility, with a varicocele detected on clinical examination or by imaging. Men presenting with infertility should be assessed with a reproductive history, semen analysis and hormone profile, including testosterone, LH and FSH.

Optimising the management of early prostate cancer

23 Apr 2020Paid-up subscribers

Men born after 1960 in the UK now have a 1 in 6 estimated lifetime risk of being diagnosed with prostate cancer. NICE recommends that men over 50 years old who request a PSA test should be fully counselled about the test beforehand. The test should also be offered to men with LUTS or an abnormal DRE. If the prostate feels malignant on DRE this should trigger a fast track referral to secondary care, via a suspected cancer pathway referral, even if the PSA is normal. Men with PSA values above the age-specific reference range should also be referred to urology urgently, via a suspected cancer pathway referral.

Managing bothersome LUTS

23 Apr 2020Paid-up subscribers

Lower urinary tract symptoms (LUTS) in men can be defined by clinical symptoms arising from the bladder, bladder neck, urethral sphincter, urethra or prostate. Benign prostatic hyperplasia (BPH) is the most common cause of LUTS. By 80 years of age almost 90% of men have developed BPH at varying symptomatic levels. If the patient’s symptoms and examination findings are suspicious of cancer then an urgent two week wait referral should be made to urology. Other reasons for referral include: complicated LUTS with recurrent or persistent UTI, retention, renal impairment, stress incontinence or bothersome LUTS not resolved by conservative or drug management.

Early recognition and treatment vital in acute prostatitis

24 Apr 2019Paid-up subscribers

Acute prostatitis is an acute bacterial infection of the prostate gland, often associated with other urinary tract infections. Patients with acute prostatitis present feeling generally unwell with fever, rigors, pelvic pain and lower urinary tract symptoms. Acute prostatitis can also present with, or lead to, acute urinary retention. Patients who are systemically unwell should be referred urgently to secondary care for intravenous antibiotics and further investigation, as should those failing to respond appropriately or deteriorating on review after 48 hours. Chronic bacterial prostatitis is characterised by symptoms that last for more than three months. 

History key in identifying cause of nocturia in men

24 Apr 2019Paid-up subscribers

Nocturia can be a symptom of an underlying disease process or behavioural. The history should not just focus on lower urinary tract symptoms but should also include past medical history, current medications and fluid intake. It is important to ask specifically about the onset and progression of symptoms, and to what extent the patient is troubled by the nocturia. An abdominal examination should always be performed and should exclude urinary retention. A digital rectal examination of the prostate should also be offered.

Identifying and managing men with early prostate cancer

23 Apr 2018Registered users

Prostate cancer is the most common cancer in men in the UK. Men have a 1 in 8 lifetime risk of being diagnosed with the disease. Factors associated with an increased risk of prostate cancer include: age > 50 years, black ethnicity, a first-degree relative with prostate cancer, and obesity. Patients may present with erectile dysfunction or lower urinary tract symptoms such as frequency, hesitancy, nocturia, or haematuria.

Managing acute and chronic urinary retention in men

23 Apr 2018Paid-up subscribers

Urinary retention is the most common urological emergency and more than 95% of cases occur in men. Acute urinary retention (AUR) is defined as the sudden inability to pass any urine voluntarily associated with a painful, palpable or percussable bladder. In chronic urinary retention (CUR) there is a non-painful bladder, which remains palpable or percussable after the man has passed urine, with a post-void residual volume > 300 ml. In acute on chronic urinary retention no urine can be voluntarily passed but the condition is relatively painless and the residual volume on catheterisation is > 1.5 litres.

Diagnosing testicular lumps in primary care

24 Apr 2017Paid-up subscribers

Although the incidence of testicular cancer has increased over the past few decades, testicular tumours are still rare and many GPs will only see one or two new diagnoses in their career. When examining scrotal swellings, the key question is whether the lump is intra- or extra-testicular, as palpable intra-testicular lesions are highly likely (around 90%) to be malignant, whereas those lying outside the testis are usually benign.

Diagnosing and managing androgen deficiency in men

24 Apr 2017Paid-up subscribers

Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns.

 

Special report

Investigating the underlying cause of erectile dysfunction

23 Jan 2019Registered users

Rates of erectile dysfunction (ED) increase with age, with an estimated 70% of men aged 70 affected to some extent. ED is a significant predictor of underlying cardiovascular disease. In addition to the onset and duration of symptoms, important points in the history to clarify are: how the patient defines their ED, whether they have ever had erectile function, whether morning erections are preserved, the context of ED and recent sexual history. Men should be asked about symptoms of hypogonadism such as loss of libido or low energy levels. Cardiovascular risk should be evaluated.

 

Urology: men and women

Fracture admissions higher in men on ADT

23 Jun 2016Paid-up subscribers

Androgen deprivation therapy (ADT) in men with prostate cancer is associated with a small but significant increase in fracture risk, a UK study has shown. Using the Hospital Episodes Statistics database for 2004-2008, the authors identified 8,902 men with prostate cancer who had been admitted to hospital with a fracture. Of these, 3,372 (37.8%) had been treated with ADT and 5,530 (62.2%) had not. There were 228,852 admissions in the background population.

What are the benefits of testosterone treatment in older men?

28 Apr 2016Paid-up subscribers

Testosterone therapy in men 65 and over with low testosterone levels produced moderate improvements in sexual function and some improvement in mood but had no effect on vitality or walking. All men enrolled were randomised to either testosterone gel or a placebo gel for one year.

 

Editorials

Should men who have sex with men be screened for hepatitis C?

21 Feb 2013Paid-up subscribers

Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.

Do 5-ARIs have a role in preventing BPH?

21 Aug 2012Paid-up subscribers

Treating asymptomatic older men with 5-alpha reductase inhibitors may reduce their risk of developing benign prostatic hyperplasia (BPH). However, the case for prophylactic use of these drugs is still unproven. Dr Jonathan Rees, GPwSI Urology, Bristol, considers the implications of new data from the long-running Prostate Cancer Prevention Trial.