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Symposium articles

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.

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. 

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.

Managing lower urinary tract symptoms in men

25 Apr 2016Paid-up subscribers

Up to 90% of men aged 50 to 80 may suffer from troublesome lower urinary tract symptoms (LUTS). A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. Based on history, examination and investigation findings an individualised management plan should be formulated.

The role of PSA in detection and management of prostate cancer

25 Apr 2016

The prostate specific antigen (PSA) test clearly provides the opportunity for clinically relevant prostate cancer to be detected at a stage when treatment options are greater and outcomes may be improved. In addition, a raised PSA may often indicate benign prostatic enlargement, and this may provide an opportunity for treatment of this condition before complications develop. However, in some patients the PSA test may lead to investigations which can identify clinically insignificant cancers which would not have become evident in a man’s lifetime.

Careful assessment key in managing prostatitis

23 Apr 2015Registered users

Prostatitis is a common condition estimated to affect up to 30% of men in their lifetime, it is most prevalent in men aged between 35 and 50. Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis. Clinical assessment includes a thorough history and examination. A digital rectal examination should be performed after a midstream urine sample has been collected for urine dipstick, microscopy and culture. The prostate should be checked for nodules.

New developments in metastatic prostate cancer therapy

23 Apr 2015Paid-up subscribers

Advanced prostate cancer remains an incurable and lethal disease. Innovation continues to provide new hope for patients with advanced disease, with improved survival while maintaining quality of life. As patients live longer with increasing treatment options, education of all healthcare professionals involved in their care is crucial in ensuring holistic care for this complex disease.

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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.

Chemotherapy with hormone therapy boosts survival in advanced prostate cancer

21 Mar 2016Registered users

The addition of docetaxel at the time of hormone therapy initiation for advanced prostate cancer improved overall survival by 10 months, in a large  randomised controlled trial. The STAMPEDE study commenced in 2005, and has recruited men with metastatic, high-risk localised or node-positive prostate cancer who were newly diagnosed or had high-risk recurrence following previous local therapy. STAMPEDE utilises a multi-arm approach to test whether addition of other agents at the time of hormone therapy initiation improves overall survival.

Can NSAIDs reduce the need for antibiotics in UTI in women?

25 Jan 2016Paid-up subscribers

Although initial treatment of urinary tract infection (UTI) with ibuprofen reduced the use of antibiotics, women had a greater symptom burden and a higher risk of pyelonephritis than those treated with antibiotics from the outset, a primary care study from Germany has found.

Prostate specific alpha blockers increase risk of falls

25 Nov 2015Paid-up subscribers

The newer prostate-specific alpha blockers produce a small but significant increase in the risk of falls in older men with lower urinary tract symptoms (LUTS), a study from Canada has shown. The alpha blocker cohort consisted of 147,084 men aged 66 years and over, starting a selective alpha blocker (84% tamsulosin). An equal cohort of matched men, not taking alpha blockers was created on a 1:1 basis. The primary outcome measures were falls and fractures 90 days after initiation of therapy. Secondary outcomes were major osteoporotic fractures, hip fractures, hypotension and head trauma.

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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.