Can J Urol
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Coordination of care between the urologist and primary care physician is critical to effective treatment of a variety of urologic conditions. Medical therapies for benign prostatic hyperplasia, erectile dysfunction, hypogonadism, overactive bladder, and prostate cancer are widely available and a basic understanding of the pathophysiology of these disease states as well as the pharmacology of existing treatment options are necessary to avoid complications and maximize efficacy associated with patient outcomes. ⋯ Major advances have been made in the therapy of castrate resistant prostate cancer as well as hormonal related skeletal events secondary to advanced carcinoma of the prostate. We provide a 2011 update of the available medications for treatment of several common urologic diseases.
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Many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists. The development of newer agents to treat many of these conditions has allowed the primary care provider to manage many of these common conditions. The use of these newer medications has become commonplace in the primary care setting. This article will update some of the most commonly used urologic medications to optimize patient management strategies by the primary care provider or in coordination with the urologist.
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Studies have repeatedly confirmed that about 52% of men between the ages of 40 and 70 years have some degree of erectile dysfunction (ED). Other studies have shown that as a man ages, his testosterone level will naturally decrease. Over the last number of years, we have also seen that ED may be one of the earliest signs and markers of endothelial dysfunction. ⋯ It is very important for the primary care physician to identify patients who are suffering from ED and/or hypogonadism, and to also identify any other existing comorbidities. This article discusses the suggested work up, diagnosis, and management of men who present with either ED or symptoms and signs suggestive of hypogonadism (low testosterone). It also discusses the potential relationship between these conditions and metabolic syndrome.
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Review Historical Article
Female circumcision: history, medical and psychological complications, and initiatives to eradicate this practice.
Female circumcision - a procedure where the parts of the female genitals are removed, which is also known as female genital cutting (FGC) or female genital mutilation (FGM) - continues to be practiced in more than 28 African countries. It is estimated that 80-100 million women have been circumcised. We performed a review of the literature to examine the history of female circumcision, its medical and psychological consequences, and government and non-government educational initiatives that are currently being taken to eradicate this practice.
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Asymptomatic microscopic and gross hematuria are common problems for the primary care physician. The exact definition of microscopic hematuria is debated, but is defined by one group as > 3 red blood cells/high power microscopic field. ⋯ Clinical evaluation of these patients often involves urological consultation with urine cytology, urine culture, imaging studies, and cystoscopy. Patients who have no identifiable cause after an extensive workup should be monitored for early detection of malignancy or occult renal disease.