Open Access

ARTICLE

A guide to the management of urologic dilemmas for the primary care physician (PCP)

Jack Barkin¹, Matt T. Rosenberg², Martin Miner³

1 Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
2 Mid Michigan Health Centers, Jackson, Michigan, USA
3 Departments of Family Medicine and Urology, Miriam Hospital, Brown University, Providence, Rhode Island, USA
Address correspondence to Dr. Jack Barkin, Department of Surgery, University of Toronto, 404-960 Lawrence Avenue West, Toronto ON M6A 3B5 Canada

Canadian Journal of Urology 2014, 21(Suppl.3), 55-63.

Abstract

Patients with urologic conditions may present to a primary care physician (PCP) in the emergency department or in the PCP’s office. Some conditions are true emergencies that require immediate surgical intervention. Others may require medical treatment or possibly simply reassuring the patient that there is no serious medical problem. Sometimes the diagnosis can be easily made, whereas other times the PCP needs to be able to rule out serious causes for a presenting problem and execute a guidelinerecommended patient work up, to make a final diagnosis. Sometimes recommended diagnostic tests may not be readily available. When a PCP believes that a patient may have a serious urologic condition and is unsure of the appropriate patient management strategy, then he or she must quickly refer the patient to a urologist. This article describes common urology-related issues—hematuria, prostate-specific antigen (PSA) test interpretation, phimosis and paraphimosis, acute scrotal pain and masses in the child and adult, urinary tract infection, renal colic, and castration-treatment-induced bone loss. It provides insights into decision-making processes for patient management of some urologic conditions, and information about managing sequelae and side effects of long term treatment. It includes practical diagnostic suggestions and patient management strategies based on the authors’ years of urologic clinical practice experience.

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