Global evaluation of men – check-up and follow-up

Abstract

Women, after childhood are rapidly attended by Gynecologists, even during puberty. They become their physicians and responsible for their follow-up. On the other hand, men routinely remain for a long period of time unattended until the 5th decade of life, when, in the best of scenarios, they visit a lot of professionals of several specialties.We could draw a long discussion about the need of medical attention between these two periods of life, but we will stick to check-up and follow-up of adult men. Usually as Urologists we are the first doctors these men interact with and at that moment we could play a definite role in providing global health evaluation.For more than one decade Brazilian Society of Urology has launched campaigns to promote Urologists as the doctor of men. With that in mind, it is important that we recognize which are the actual needs of periodical medical care for these men. Which is the minimal evaluation should we propose to an adult man?Basically it is necessary a detailed anamnesis and physical exam in order to evaluate several body systems. On the contrary, since there are plenty of subsidiary exams and tests available for each specialty, it is important to stablish which are important for our target population, in order to evaluate these men efficiently. The guidelines of medical specialties provide information on this matter. They are not absolute rules, but allow for a specialty approach based on medical literature with high level of evidence. Another important aspect to be considered is that in the last 80 years we moved from an infectious diseases scenario to a pattern similar to richer countries, with mainly cardiovascular and neoplastic diseases (1). We must take into account the high prevalence of such illnesses when we decide which routine periodic evaluation to adopt.Several models and scores were developed in order to create "Cardiovascular Risk Stratification", and the parameters are a mandatory part of this evaluation. Basic characteristics as age, smoking, diabetes mellitus, blood pressure, total cholesterol and fractions HDL and LDL can help define the risk of cardiovascular diseases as low, intermediate or high. This evaluation should be usually made since 40 years old and on, and the individuals with familial history of cardiovascular diseases must anticipate this approach in 10 years (2). Rest electrocardiogram, a noninvasive exam, easy to perform, may be proposed for asymptomatic men routinely, and echocardiogram must be reserved for hypertensive adults. Some exams, although popular, are not still fully validated and are not routinely indicated. For example, exercise testing, calcium score and carotid ultrasound are suggested by cardiologists for intermediate and high risk individuals (3).It is also notorious based on the foregoing, that metabolic parameters significant role in the evaluation of adult man. Investigation of a potential glucose intolerance, for example, should begin at 45, repeated at intervals of one to three years. The dosage of