From the Guidelines
Australian urology guidelines prioritize managing urinary retention, hematuria, and catheter problems, with a focus on minimizing morbidity, mortality, and improving quality of life. For urinary retention, initial management involves inserting a urethral catheter (14-16Fr), with suprapubic catheterization as an alternative if urethral insertion fails, as recommended by various studies 1. Hematuria requires assessment of hemodynamic stability, with three-way irrigation catheters (20-24Fr) for clot evacuation in severe cases. Catheter problems often involve blockage requiring flushing with 30-50mL of sterile saline or replacement if unsuccessful. Common urological surgeries include:
- Transurethral resection of the prostate (TURP) for BPH
- Radical prostatectomy for prostate cancer
- Nephrectomy for renal tumors with post-operative care focusing on catheter management, pain control, and monitoring for complications like bleeding or infection, as outlined in the guidelines 1. In outpatient follow-up, BPH management involves symptom assessment using the International Prostate Symptom Score (IPSS), with treatment options ranging from watchful waiting to medications like alpha-blockers (tamsulosin 0.4mg daily) or 5-alpha reductase inhibitors (finasteride 5mg daily), as recommended by the American Urological Association guidelines 1. PSA monitoring typically occurs every 6-12 months for men with elevated risk, with levels >4ng/mL generally warranting further investigation, as suggested by the American Cancer Society guidelines 1. Post-cancer treatment surveillance varies by cancer type but generally includes regular imaging, blood tests, and symptom assessment, with prostate cancer patients requiring PSA monitoring every 3-6 months for the first two years, then less frequently if stable, as recommended by the European Society for Medical Oncology guidelines 1. Some key points to consider in urology practice include:
- The importance of accurate diagnosis and staging of prostate cancer, as well as the role of PSA testing in monitoring disease progression
- The need for individualized treatment plans, taking into account patient preferences, comorbidities, and disease characteristics
- The importance of regular follow-up and surveillance after treatment, to monitor for recurrence and manage long-term complications. Overall, the goal of urology practice is to provide high-quality, patient-centered care that minimizes morbidity, mortality, and improves quality of life, as emphasized by the guidelines 1.
From the Research
Urology Guidelines Australia
Common Ward Calls on Urology
- Urinary retention is a common issue, with benign prostatic hyperplasia (BPH) being a major cause, accounting for 53% of cases 2
- Other causes of urinary retention include infectious, inflammatory, iatrogenic, and neurologic factors 2, 3
- Initial evaluation should involve a detailed history and physical examination, including measurement of postvoid residual (PVR) volume of urine 2
Common Surgeries in Urology
- Surgeries for urinary retention, such as catheterization, may be necessary to relieve obstruction 3, 4
- Other urologic emergencies, such as penile fracture, priapism, Fournier gangrene, and testicular torsion, may require surgical intervention 4
Common Follow-up Issues in Urology Clinic
- BPH and prostate-specific antigen (PSA) level monitoring are important aspects of urology follow-up 2
- Post-urology cancer treatment follow-up is crucial to monitor for potential complications and recurrence 5
- Management of urinary retention, including conservative treatment, drug therapy, and surgery, depends on the underlying cause 3