MANAGEMENT OF COMMON UROLOGICAL PROBLEMS

INTRODUCTION

Now that I have retired from my private practice of medicine, I have been strongly encouraged by family and friends to share my management of particular urological problems with my medical colleagues and the lay community.

The material presented herein is not intended to provide a thorough analysis of the issues since details of diagnostic and therapeutic modalities can be found in medical publications. But it is incumbent on the physician--be that person the primary care physician or a specialist--to present all options to the patient and most importantly to be sensitive to the patient’s responses. Close observance of the patient’s verbal and body language is critical. There should be an interactive discourse between the patient and physician. The physician should conduct this meeting in a relaxed environment as free from time constraints as possible.

I have tried to cover some of the more common problems encountered in my urological practice. Each of the conditions discussed is introduced by a letter from the referring physician outlining the issues of concern. This is followed by my response, in which I attempted to impart my thoughts and recommendations in an instructive yet informal style. Although these cases are based on actual encounters, the names of the people involved have been altered to insure their privacy. One basic tenet has always guided my approach to the patient: the cure must never be worse than the disease. Many diagnostic and therapeutic measures have attendant risks which may actually be more damaging than the underlying medical problem itself. Indeed, not all abnormalities need active treatment. Therefore, whatever diagnostic or therapeutic modalities I suggested, I tried to evaluate their risk/benefit ratio in light of the natural course of the disease. Before embarking on any particular plan, I discussed the options with the patient (and included family members if the patient so desired). Occasionally surveillance only was my recommendation and some patients felt uncomfortable with a non-active approach. As I so often tell my referring physicians: one of the hardest things for a doctor to do is to do nothing.)