The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.
Lower urinary tract infections are common in the community and in hospitals.Management of acute uncomplicated infections in non-pregnant women is usually simple and involves antibiotic treatment for 3-5 days.Infections in men and recurrent, drugresistant or complicated urinary tract infections require further evaluation. Confirming the cause is important to ensure the best treatment. 'uncomplicated' urinary tract infection is one in which there are no structural or functional abnormalities within the urinary tract. A physical examination includes checking vital signs, as well as abdominal and flank examination. When required, external genital examination may show atrophic vaginitis in females and phimosis or meatal stenosis in men.Rectal examination may reveal an enlarged prostate or tenderness to suggest acute prostatitis in males.A urine dipstick (e.g. for nitrites, leukocyte esterases) can indicate the presence of a urinary tract infection.
Selected cases of small renal masses can be observed with low risk of metastases, but this does not equate to zero risk. Nephron sparing surgery such as laparoscopic partial nephrectomy or open partial nephrectomy offers optimal oncological outcomes, nephron preservation and improved general prognosis. While there are no 'gold standards' in the management of the small renal mass, laparoscopic partial nephrectomy has demonstrated improving outcomes and minimal complications in the hands of an experienced surgeon. The challenge will be to encourage adoption of this technique, to ensure proficiency, but also be cognisant of the potential risks for lower volume surgeons. The role of ablative procedures is limited to the poor surgical candidate, and as an alternative to the technically difficult laparoscopic procedure. Until long-term data is available, this position is unlikely to change.
Abstract• Urofl owmetry is an essential investigation that can assist in the diagnosis of common lower urinary tract dysfunctions.• This article describes key aspects on performing and interpreting the test.
In the year following a radical prostatectomy, most men recover from any initial urinary incontinence. Nonetheless, incontinence greatly affects a man's quality of life during that time, as it does for those who have persistent incontinence thereafter. Urological assessment should be thorough in order to ensure that no treatable etiology exists aside from stress incontinence. Conservative measures can then be applied from the earliest stages, and offer benefit for those with mild to moderate symptoms. Failing this, a wide variety of surgical options can be considered. For effective outcomes, a clinician must ensure that surgical decision-making is based on current evidence and patient preference, and that it considers possible morbidities.
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