The Medical clinics of North America
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Med. Clin. North Am. · Jan 2011
ReviewMale lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).
Male lower urinary tract symptoms, benign prostatic hyperplasia, enlargement of the prostate, and bladder outlet obstruction are common among aging men and will increase in socioeconomic and medical importance at a time of increased life expectancy and aging of the baby boomer generation. This article reviews the epidemiology, management, and therapeutic options for these conditions. ⋯ Despite the efficacy of medical therapy, there will be patients who require referral to a urologist either early, to rule out prostate cancer and other conditions, or later, after initial medical therapy and lifestyle management has failed. Perhaps as many as 30% of patients fail to achieve sufficient symptom improvement with medication, lifestyle adjustment, and fluid management, and may require more invasive or surgical treatment options.
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Med. Clin. North Am. · Jan 2011
ReviewMajor urologic problems in geriatrics: assessment and management.
Elderly urologic patients require the same cautions as used in development of treatment programs for them in other disciplines. Because of potential interference with poor renal function or crossover effects with central or peripheral nervous system, however, many urologic drugs must be titrated appropriately. In treating cancer, erectile dysfunction, incontinence or urinary infection, patient quality of life and life span become dominant factors in making therapeutic decisions, by behavioral change, medication, or surgical intervention.
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Med. Clin. North Am. · Jan 2011
ReviewLong-term follow-up and late complications following treatment of pediatric urologic disorders.
Many pediatric urologic disorders have sequelae that may affect patients well into adulthood. Despite adequate treatment, many patients are at risk for progressive urologic deterioration years after surgical reconstruction. While many pediatric urologists follow their patients years after surgery, screening for late complications is a shared responsibility with primary care providers. This article discusses potential late complications and appropriate follow-up for patients who have a history of ureteral reimplantation, pyeloplasty, hypospadias repair, posterior urethral valve ablation, and intestinal interposition.
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Although lifespan has dramatically improved in the human immunodeficiency virus-positive (HIV+) population, HIV and its treatment continue to be a source of substantial morbidity in many organ systems, including the genitourinary tract. As the number of long-term survivors increases with advances in antiretroviral therapy, age-associated urologic symptoms are also becoming increasingly relevant considerations for people living with HIV. Primary care physicians have a major role to play in maintaining the genitourinary health of their HIV+ patients. ⋯ In this article the authors review the management of the genitourinary system in patients with HIV infection. Particular consideration is given to urinary tract infections, lower urinary tract symptoms, renal insufficiency, sexual and fertility problems, and cancers of the genitourinary tract. Management algorithms are outlined and indications for referral to a urologist are emphasized.
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Since the introduction of prostate-specific antigen (PSA) screening in the late 1980s, more prostate cancers have been detected, and at an earlier stage. As a consequence, the majority of prostate cancers are now detected years before the emergence of clinically evident disease, which usually represents locally advanced or metastatic cancer. ⋯ With this long natural history and a median survival without treatment that often approaches at least 15 to 20 years, many clinicians and researchers have questioned if prostate cancer screening and treatment actually improves survival, as many patients will die with prostate cancer rather than of prostate cancer. In this review, the authors discuss the rationale for prostate cancer screening and present the current guidelines for the use of PSA.