Primary care
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Rheumatoid arthritis is an inflammatory disease of the joints causing pain and stiffness, pathologically characterized by chronic synovitis. Without proper treatment, it progresses to cause joint deformity that results in significant loss of function. ⋯ Patients from all age groups can acquire the disease, hence the additional categories of juvenile onset and elderly onset rheumatoid arthritis. Disease-modifying antirheumatic drugs are the mainstay of therapy, and should be initiated as early as possible in the course of the disease in consultation with a rheumatologist.
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Prostate specific antigen (PSA) screening is an integral part of current screening for prostate cancer. Together with digital rectal examinations, it is recommended annually by the American Cancer Society. PSA screening has resulted in a significant stage migration in the past decades. ⋯ Other aspects of the screening process include age at diagnosis, survival, overdiagnosis, and overtreatment. Recent studies have cast doubt on whether PSA screening positively affects mortality and how the quality of life of patients may be affected by screening. Future considerations include the need for more longitudinal studies as well as further study of the PSA components that may become more relevant in the future.
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A variety of penile problems are commonly seen by primary care physicians. This article reviews the diagnosis, evaluation, and management of congenital conditions such as hypospadias, chordee, webbed and buried penis, duplicated urethra, ambiguous genitalia, and micropenis. Acquired emergent conditions, including minor trauma and paraphimosis, are also discussed, with a particular emphasis on initial evaluation and management. Conditions associated with erectile dysfunction, including priapism and Peyronie disease, are reviewed.
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Scrotal and testicular problems range from the benign and painless to the malignant and debilitating. The primary care physician should be able to triage these problems and know when to give reassurance and when to initiate a targeted workup that may lead to specialist intervention. ⋯ Scrotal pain includes well-defined acute causes such as torsion and infection and the less well-defined chronic orchialgia. Palpable abnormalities covered here include cryptorchidism, hydrocele, spermatocele, varicocele, and testicular cancer.
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Causes of hematuria can range from benign conditions such as urinary tract infection to serious conditions such as bladder cancer. In evaluating a patient with hematuria, 3 questions must be answered by the primary care physician: (1) Is it really hematuria? (2) Should this patient with hematuria be worked up, and if so, how? (3) Should this patient with hematuria be referred, and if so, to which specialty? This article addresses these questions. Because uniformly high-quality studies are lacking, the recommendations included in this article are mostly based on expert consensus.