Open Access

GUEST EDITORIAL

Grannum R. Sant
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 1-1, 2008
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GUEST EDITORIAL

Martin Miner, David Greenberg, Matt Rosenberg, Claude Laroche
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 2-2, 2008
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Mark LaSpina, Gabriel P. Haas
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 3-13, 2008
Abstract Early detection of prostate adenocarcinoma (prostate cancer) through screening tests such as a serum prostatespecifi c antigen (PSA) test and a digital rectal examination (DRE) enables primary care physicians and urologists to offer patients a broader choice of treatments that are also more likely to provide a cure. Whether men are being over treated or over diagnosed through the widespread use of screening tests remains controversial. This review aims to provide general practitioners with a better understanding of different prostate cancer tests that can be performed and to help them decide which patients should be More >

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Kylea Potvin, Eric Winquist
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 14-20, 2008
Abstract Objective: To provide a current and evidence-based clinical review of practical value to primary care physicians encountering men with hormone-refractory prostate cancer (HRPC) in their practice.
Methods: Evidence-based narrative review by two expert clinicians incorporating results of systematic reviews and randomized trials whenever available.
Results: HRPC represents the final common pathway to death from prostate adenocarcinoma, the single most prevalent cancer in Canadian men. However, primary care physicians will not encounter these patients with a frequency adequate to develop confidence in their care. HRPC is defined by progressive disease despite castration, and biologically is a characterized by androgen… More >

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Jack Barkin
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 21-30, 2008
Abstract Benign prostatic hyperplasia (BPH) is one of the commonest causes of lower urinary tract symptoms (LUTS) in men over age 50. Fifty percent of men over age 50 will require some type of management for BPH/LUTS symptoms. Until about 15 years ago, the most common management for BPH was a transurethral resection of the prostate (TURP) operation. Initially, once a diagnosis of BPH has been made, most men are treated medically. One must fi rst rule out other serious causes of these symptoms, such as prostate cancer, bladder cancer, and other obstructions. For men with… More >

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Lesley K. Carr
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 31-36, 2008
Abstract Overactive bladder (OAB) is a common condition (prevalence 14%-18% of Canadians) and has a signifi cant negative impact on quality of life. OAB may be idiopathic or may occur with other common conditions such as bladder outlet obstruction, neurological disease, or stress incontinence. Primary care physicians may safely diagnose this condition by history and physical exam with a minimum of widely available lab tests. Management with behavioral therapies and pharmacotherapy is generally quite successful and warranted. Multiple anticholinergic medications are available and have been shown to be effective. Subtle differences in structure and mechanism of More >

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Audrey Wang, Lesley K. Carr
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 37-43, 2008
Abstract Introduction: Stress urinary incontinence is a common and costly condition amongst community dwelling women. It can have a significant negative impact on the quality of life, and yet less than half of women with urinary incontinence seek medical attention. It is important for primary care physicians to have a clear understanding of stress urinary incontinence in order to screen and manage patients who may have bothersome symptoms.
Objective: This article aims to outline the terminology, pathophysiology, clinical evaluation and treatment of female stress urinary incontinence.
Conclusion: Female stress urinary incontinence can be effectively evaluated and managed in the More >

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Carl G. Klutke¹, John J. Klutke²
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 44-53, 2008
Abstract Interstitial cystitis also known as painful bladder disorder refers to individuals with chronic bladder infl ammation of unknown cause. The presentation of disabling symptoms of urgency, frequency, nocturia, and varying degrees of suprapubic discomfort, is one that the primary care physician will encounter frequently as the prevalence of interstitial cystitis ranges from 10.6 cases per 100,000 to as high as one in 4.5 women, depending upon the criteria used for its diagnosis. Many etiologies are possible. The disorder can be divided clinically into two groups—ulcerative and non-ulcerative—based on cystoscopic findings and response to treatment. In More >

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Jitesh V. Patel¹, Christopher V. Chambers², Leonard G. Gomella¹
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 54-62, 2008
Abstract Asymptomatic microscopic and gross hematuria are common problems for the primary care physician. The exact defi nition of microscopic hematuria is debated, but is defi ned by one group as > 3 red blood cells/high power microscopic fi eld. While the causes of hematuria are extensive, the most common differential diagnosis for both microscopic and gross hematuria in adults includes infection, malignancy, and urolithiasis. Clinical evaluation of these patients often involves urological consultation with urine cytology, urine culture, imaging studies, and cystoscopy. Patients who have no identifi able cause after an extensive workup should be More >

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James C. Brien, JC Trussell
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 63-70, 2008
Abstract Introduction: Erectile dysfunction (ED) affects more than half of men between the ages of 40 and 70 years and is associated with a significant decline in quality of life. ED in an otherwise healthy man should be considered a sentinel event for endothelial dysfunction and cardiovascular disease. Such a person should be carefully evaluated for undiagnosed risk factors including hypertension, diabetes, lipid disorders, and obesity.
Objective: To understand that erectile dysfunction is prevalent and may be the first sign of undiagnosed cardiovascular risk factors.
Materials and methods: Literature review.
Results: Current literature suggests that physicians should screen all men More >

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Richard W. Casey¹, Jack Barkin²
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 71-77, 2008
Abstract Testosterone replacement therapy (TRT) can have signifi cant benefi cial effects in the appropriate hypogonadal male patient. Testosterone defi ciency is common in primary care practice and recognition of the signs and symptoms of this abnormality will allow physicians to choose appropriate interventions. The symptoms of clinical hypogonadism include muscle weakness, fatigue, mood changes and a reduced libido. Signs include a reduced muscle mass, osteoporosis, anemia and increased adiposity.
While routine screening for testosterone defi ciency, determination of testosterone levels in high risk populations, including obesity and diabetes, will help the clinician direct TRT to More >

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Paul R. Gittens¹, Costas D. Lallas¹, Mark L. Pe¹, Robert Perkel², Christine Folia³, Leonard G. Gomella¹
Canadian Journal of Urology, Vol.15, Suppl.4, pp. 78-91, 2008
Abstract Advances in the understanding of the pathophysiology of a variety of urological disorders have resulted in the development of novel medications to manage these diseases. While many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists, the use of these newer medications has become commonplace in the primary care setting. For example, symptomatic benign prostatic hyperplasia therapy, while historically treated with primary surgical intervention, is now commonly initially managed with medical therapy. Prostate cancer patients are being treated with newer formulations of long term hormone… More >

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