Urology - Major articles

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.

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.

GPs could play key role in prostate cancer survivorship programmes

24 Nov 2014Paid-up subscribers

More than 80% of men diagnosed with prostate cancer can expect to survive for at least five years. Up to 87% of men with prostate cancer may have unmet supportive care needs. Patients regularly cite psychological and sexual issues as the most significant. Poor functional outcomes after treatment such as incontinence and erectile dysfunction have a major impact on quality of life. The key elements of a survivorship programme are: education, intervention, surveillance and co-ordination of care. Interventions which may improve immediate care include: structured holistic needs assessment and care planning, treatment summaries and cancer care reviews, patient education and support events and advice about, and access to, physical activity schemes. [With external links to the evidence base]

Improving the management of urinary incontinence

20 Mar 2014Paid-up subscribers

Urinary incontinence is a common condition that is likely to be under-reported. Its frequency increases with age, parity, high BMI, and associated comorbidities. The history should include the circumstances in which the incontinence occurs, the duration and how it affects the patient’s quality of life. The initial assessment should include enquiring for symptoms of urinary tract infection and carrying out a urine dipstick test. [With external links to the current evidence base]

Prompt diagnosis key in bladder cancer

22 Jan 2014Registered users

Bladder cancer is the most frequently diagnosed cancer involving the urinary tract. Delayed diagnosis is associated with high-grade muscle invasive disease which has the potential to progress rapidly, metastasise and is often fatal. Haematuria which is typically intermittent, frank, painless and at times present throughout micturition is the classical and most common presentation of bladder cancer. However, irritative symptoms such as dysuria, urgency, urge incontinence and frequency as well as obstructive symptoms i.e. feeling of incomplete voiding, intermittent stream and straining can also be experienced. [With external links to the current evidence base]

Advances in the treatment of metastatic prostate cancer

25 Apr 2013Paid-up subscribers

Prostate cancer is the most common cancer in men in the UK. It accounts for nearly a quarter of all male cancer diagnoses and is the second most common cause of male cancer death. Most patients present with localised disease, but there are still many who present with metastatic disease. Medical castration using LHRH analogues has become the gold standard in managing both locally advanced prostate cancer, in combination with radiotherapy, and metastatic disease. Eventually most men with advanced prostate cancer become resistant to androgen deprivation therapy. This is called castrate refractory prostate cancer, and is associated with a poor prognosis. There is now hope for patients who progress after chemotherapy with the emergence of several new agents that have been shown to benefit patients. [With external links to the current evidence base]

Is there a link between BPH and prostate cancer?

25 Apr 2012Paid-up subscribers

GPs are playing an increasing role in managing both prostate cancer and benign prostatic hyperplasia (BPH). More than 70% of men over 70 years are affected by BPH, and prostate cancer is the most common cancer in men in the UK. GPs play an important part in the initial management of men presenting with lower urinary tract symptoms and in addressing concerns regarding prostate cancer and the significance of the patient’s symptoms. While there is no proven causal link between prostate cancer and BPH, associations have been found. BPH may increase the chance of an incidental prostate cancer being diagnosed through PSA testing and other investigations.  [With external links to current evidence and summaries]

Treating nocturnal enuresis in children in primary care

21 Jun 2011Paid-up subscribers

Nocturnal enuresis is defined as involuntary wetting while asleep at least twice a week in children over the age of five. Primary nocturnal enuresis describes those children who have always been wet. Secondary nocturnal enuresis is defined as a relapse after a child has been completely dry for at least six months. Up to the age of nine years, nocturnal enuresis is twice as common in boys than girls but thereafter there is no sex difference in prevalence. At the age of five, 2% of children wet every night, and 1% are still wetting every night in their late teens. Bedwetting is not primarily caused by an underlying psychological disorder. However, psychological problems and life events can exacerbate or precipitate bedwetting in susceptible children who have a genetic basis for their condition.

Improving lower urinary tract symptoms in BPH

19 Apr 2011Paid-up subscribers

Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men.Histological (microscopic) BPH, which is characterised by both stromal and glandular hyperplasia, is present in more than 60% of men beyond their sixties. More than 40% of men in this age group have lower urinary tract symptoms (LUTS) and about half this group have impaired quality of life. The prevalence increases with age, and the overall number of patients affected is rising worldwide as populations age. At current intervention rates, about one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically, although this may be falling. The remainder will often be managed initially by watchful waiting. However, the majority of these individuals suffer gradual progression of symptoms and the bother associated with them, and increasingly require treatment either with medication or surgery. [With external links to the evidence base]

Managing patients with acute urinary retention

18 Apr 2011Paid-up subscribers

Acute urinary retention (AUR) is a common urological emergency. AUR is more than ten times more common in men than women. AUR in men tends to occur in the elderly and the risk of AUR is higher in men > 70 years. Those in this age group have a 10% risk of developing AUR over a five-year period. The incidence of AUR is low in the general male population of 45 years or older.  However, in almost 50% of AUR patients with benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), AUR was their first symptom. GPs can play a major role in identifying patients who need assessment for BPH/LUTS and starting early treatment with pharmacotherapy. Health education should address the importance of compliance with medication and patients should be followed up to reduce the risk of AUR and surgical intervention. Urological intervention may only be required in cases where specialised assessment or treatment is needed and in patients where catheter insertion has failed during an episode of AUR.

Urinary incontinence in women: diagnosis and management

21 Mar 2010Registered users

Urinary incontinence can affect women of all ages. Incontinence may seriously influence the physical, psychological and social wellbeing of affected individuals, and the impact on the families and carers may also be profound. There are more than 3.5 million sufferers in the UK. [With external links to the current evidence base]

Advances in the diagnosis and treatment of prostate cancer

15 Feb 2010Paid-up subscribers

GPs are increasingly becoming involved in the care of patients with prostate cancer. Prostate cancer is currently diagnosed in more than 34,000 men every year. It claims more than 10,000 lives per annum in the UK, and many more than that internationally. Men dying from advanced disease often suffer intractable bone pain and debilitating lower urinary tract symptoms which have a considerable impact on their quality of life. In the absence of a breakthrough [ time of writing 2010] in the treatment of metastatic disease, earlier diagnosis and more effective eradication of clinically significant disease currently seem to afford the best opportunity of stemming the tide.  [With external links to current evidence and summaries]

Diagnosing urological disorders in ageing men

14 Feb 2010Registered users

Urology practice includes large numbers of ageing men presenting with urinary symptoms, haematuria, urogenital cancer and sexual dysfunction. As with women, hormonal changes in men may be associated with significant health-related problems. Often symptoms are misleading in older patients and may be related to different pathology. [ With external links to the evidence base]



Androgen deprivation therapy and cardiovascular risk

24 Sep 2015Registered users

An awareness of CVD risk allows GPs to look proactively at modifiable risk factors in these men, to encourage smoking cessation, weight loss and increased exercise – all of which have been independently associated with improved prostate cancer outcomes in their own right – and to consider medical treatment for risk factors such as dyslipidaemia.

Medical therapy ineffective for aiding passage of ureteric stones

22 Jun 2015Registered users

The findings from this large, well designed randomised controlled trial which showed no benefit for medical expulsive therapy in expectant management, together with the fact that both alpha-blockers and calcium channel blockers have a significant side-effect profile, make a case for changing clinical practice.


Clinical reviews: Urology

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.


Current evidence - prostate cancer

US: National Cancer Institute

PDQ® (Physician Data Query) is NCI's cancer database of  peer-reviewed, regularly updated evidence-based, referenced summaries

Prostate prevention 
Prostate screening  
Prostate treatment

UK: NICE- evidence search results
Prostate cancer   
Cancer survivorship
Cancer prostate survivorship

Cochrane Reviews 
Prostate cancer


PubMed is a database of the US National Library of Medicine/National Institutes of Health

Metastatic prostate cancer 
Benign prostatic hyperplasia and prostate cancer 
BPH relation to prostate cancer 
Palliative care at home 
Causes of prostate cancer - reviews   
Early prostate cancer - reviews
Prostate cancer survivorship - reviews

National Cancer Survivorship Initiative


Macmillan Cancer Support


The Urology Foundation

Prostate Cancer UK

British National Formulary
Malignant disease and immunosuppression

Cancer Research UK
Prostate cancer statistics

Early diagnosis in primary care
UK Risk Assessment Tools
Qcancer men

UK Early diagnosis programmes
Macmillan - early diagnosis