ABSTRACT
Primary care physicians frequently encounter patients with urogenital diseases. These 10 evidence-based pearls will help physicians to refine the care they provide, avoid some common missteps, and more quickly determine when a referral is appropriate.
- Copyright © 2024 The Cleveland Clinic Foundation. All Rights Reserved.
- Neil M. Paige, MD, MSHS⇑
- VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Address:
Neil M. Paige, MD, MSHS, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Room 3205, Mailcode 111A, Los Angeles, CA 90073; neil.paige{at}va.gov
- Joseph D. Shirk, MD
ABSTRACT
Primary care physicians frequently encounter patients with urogenital diseases. These 10 evidence-based pearls will help physicians to refine the care they provide, avoid some common missteps, and more quickly determine when a referral is appropriate.
- Copyright © 2024 The Cleveland Clinic Foundation. All Rights Reserved.
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- 1. Advise older men with benign prostatic hyperplasia to avoid common anticholinergic and sympathomimetic medications to reduce their risk of developing acute urinary retention
- 2. Manage acute urinary retention in male patients with benign prostatic hyperplasia by placing a Foley catheter for bladder decompression, starting them on an alpha-1 adrenergic antagonist, and ordering a voiding trial within 1 to 2 weeks
- 3. Investigate—rather than dismiss—the presence of microscopic hematuria in patients taking an antiplatelet or anticoagulation medication
- 4. Know the reasons why urology should be contacted urgently. Red or reddish-brown urine does not always require urgent urology referral
- 5. Blood in the ejaculate is alarming to patients but is almost always benign—consider infection, medical procedures, and even possible parasite encounters during recent travel as potential causes
- 6. Refer to Bosniak grading and American Urological Association guidelines to inform the management of kidney lesions found incidentally on cross-sectional imaging. Many lesions are cysts that require no further evaluation, but some cysts and all solid masses require further imaging
- 7. Advise patients taking SGLT-2 inhibitors that the medication is associated with lower urinary tract symptoms and a small but significantly increased risk of urogenital infections
- 8. Refer patients with Peyronie disease, a condition that is not rare, to a urologist if it impairs their ability to have intercourse
- 9. Avoid treating asymptomatic bacteriuria with antibiotics unless the patient falls into 1 of 3 exceptions to the “do not treat” rule
- 10. Refine your approach to prostate-specific antigen (PSA) screening by considering age-specific reference ranges, watching for medications that can alter PSA results, and focusing on a PSA value’s “velocity” when considering a referral
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