Urology is the branch of medicine that deals with issues related to the urinary tract (kidneys, ureters, bladder and urethra).
Our CASES reviewers can help give advice on the options available for patients. This page provides resources for GPs that may help with managementof a range of common issues
1. Haematospermia . In most men this is usually benign and self-limiting.
- Men <40yo- the most common cause is infection
- Men >40yo- consider underlying malignancy
- Examine BP, external genitalia, prostate/DRE
- Investigate in primary care for STIs, UTIs, prostatitis and untreated hypertension. Consider FBC, coagulation screen , U+E and LFTs and scrotal USS if indicated.
- Consider a urology referral in the following groups:
- Men under 40 with no other cause found and over 10 episodes of haematospermia
- Any man with findings suggestive of a prostate or testicular/urological malignancy
- Where haematospermia continues despite treatment of suspected underlying cause
- Men over 40 after even one episode unless it occurs following recent prostate biopsy
Remember that if men have had an invasive procedure on the prostate that haematospermia should resolve within 3 to 4 weeks
2. Recurrent UTIs
- Please consider arranging an abdominal USS for all patients with recurrent UTIs. For some patients this will facilitate appropriate management in primary care without need for referral. For those who are being referred, they will all need an USS so completion in primary care will facilitate timely further investigations.
- Please see the new guidance on recurrent UTI drafted by urology and Microbiology at STH with a GP friendly verion on the pRESS portal
3. Peyronie`s Disease is a distressing condition, often painful initially, settling normally in time If considering referral for Peyronies please check the following points first
- Is the penis too bent for penetration?
- Is there lost of tumescence during erection distal to the plaque (or other associated erectile dysfunction)
- Has the disease been stable for at least 6 months?
In these cases, referral to urology for consideration of surgery may be warranted..
4. Erectile dysfunction – this can be a CVS red flag. A full CVS work up is warranted. Many of these patients can be managed in Primary Care.
(BASHH guidelines) PDe5 inhibitors are effective in up to 80% of patients with ED but remember:
- Give sufficient tablets for a reasonable trial. If men have not had adequate erections for some time ( which is common at presentation) then supply enough doses for them to try regularly for up to 4 weeks e.g. sildenafil 50mg 12 tablets ( 3 times a week for 4 weeks)
- If men don’t at first respond to generic sildenafil, consider a trial of tadalafil, vardenafil or avanafil as a second or third agent trial may be effective. Remember though that some these drugs are still subject to Schedule II restrictions so may only be available to some patients on a private prescription
- Remember that Alpha Blockers and Finasteride used in the treatment of LUTS can cause a deterioration in ED
- Men with co-existing LUTS and Erectile dysfunction will sometimes respond well to both problems with daily tadalafil 5mg alone.
Varicoceles are seen in 10% of otherwise normal males. The development of a right-sided varicocele should always raise suspicion of a retroperitoneal tumour. The sudden onset of a left -sided varicocele in an older man may also indicate the development of a significant left renal tumour.
Asymptomatic varicoceles require no treatment and therefore do not require referral to urology.
20% of infertile men have a varicocele which may be implicated in their infertility, but NICE guidance suggests referral for surgical intervention is not recommended for this indication as there is no evidence for a change in fertility.
Patients should be advised that they may be referred on to Radiology for embolization which is a daycase procedure done through LA puncture in groin.
Likely 90% chance of cosmetic improvement and 50-70% chance of improving pain. 10-15% risk of recurrence.