Australian Family Physician October - Urology
Vol 40, (10) 745-840
The theme for the October issue of AFP is urology. This
month's articles include urinary stone disease, incidentally detected
small renal masses, localised prostate cancer, lower urinary tract
symptoms, antenatal screening, etonogestrel implants and
pericarditis.
Incidentally...
Kath O’Connor
Sometimes I wonder what medical secrets
my body holds. Do I have gallstones just
waiting for the next meal of fish and chips to erupt into biliary colic? What degree of osteoarthritis is accumulating unseen in my spine? How much atherosclerosis
is silently mounting up in my arteries?
Then again, knowing the answers to
these questions is unlikely to enhance my life. Unless these abnormalities become symptomatic, I am probably better off not knowing. Better to carry some secrets with me to the grave.
Capacity census – a pilot study of general practices in Western Australia
Tom Brett, Diane Arnold-Reed, Cam Phan, Frank Jones
The GP Super Clinics that will provide
multidisciplinary primary care services
are seen as a key feature of the Federal
Government's health infrastructure
development.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
BPH – management in general practice
Janice Charles, Lisa Valenti, Helena Britt
From April 2009 to March 2011 in BEACH, benign prostatic
hyperplasia/hypertrophy (BPH) was managed at a rate of six
per 1000 general practice encounters with male patients aged
18 years and over, suggesting it was managed by general
practitioners about 228 000 times per year nationally.
Lower urinary tract symptoms – current management in older men
Mohan Arianayagam, Ranjan Arianayagam, Prem Rashid
Lower urinary tract symptoms (LUTS) are a common
problem in men and may impact significantly on quality
of life. Symptoms may be divided into: voiding, storage,
or a combination of both.1 Incidence increases with age
(Figure 1). In this article we provide an approach to nonneurogenic
LUTS in older men and discuss management
strategies. In particular, we focus on pharmacological
therapies as these are easily commenced in the primary
care setting.
Localised prostate cancer – current treatment options
Gillian Duchesne
Prostate cancer is the most commonly diagnosed cancer
in men, with over 19 000 cases diagnosed in Australia
in 2007. The majority of men have minimal or no local
symptoms, and have disease localised to the prostate
or immediately surrounding tissues (locally advanced),
determining the T stage (Figure 1). Nodal and distant
metastases represent advanced disease. This article
focuses on localised prostate cancer; treatment of
advanced disease is beyond the scope of this article.
Urinary stone disease – assessment and management
Finlay Macneil, Simon Bariol
Data from the Australian Institute of Health and Welfare
showed an annual incidence of 131 cases of upper urinary
tract stone disease per 100 000 population in 2006–2007.1
An upper urinary tract stone is the usual cause of what is
commonly called ‘renal colic’, although it is more technically
correct to call the condition ‘ureteric colic’.
Incidentally detected small renal masses – investigation and management
Kantha Rao, Peter L Royce
Case study: Joan, 64 years of age, has a past medical history
of hypertension, rheumatic fever, appendicectomy
and cholecystectomy. She presented to her general
practitioner with difficulty in swallowing. Joan was
otherwise well with no constitutional symptoms and no
recent weight loss. She was suspected to have a foreign
body lodged in her oesophagus.
Antenatal screening – the first and second trimester
Leonard Bonacquisto
Antenatal screening is performed in the first or second trimester to determine
whether a pregnant woman’s baby has an increased risk of having Down syndrome (a
chromosomal abnormality affecting one in 500 pregnancies), Edward syndrome (one
in 3000) or open neural tube defects (one in 750). First trimester screening combines
results from a blood test with a nuchal translucency and nasal bone obstetric scan
during the first trimester of pregnancy. Second trimester screening requires only
a blood test. The screening approach varies across Australia; this article primarily
describes the Victorian protocol.
Dilated pupils, dry mouth and dizziness – a case study
Sadiq Jamali
Case study:
A man, 44 years of age, presented with a 4
hour history of dizziness, blurred vision, dry
mouth and dilated pupils. He was previously
well and on no medications and there was no
history of recent drug use, head injury or focal
neurological symptoms. On questioning, the
patient said that he had eaten lupini beans
for lunch but that he hadn’t had enough time
to soak them for long enough before eating
them.
Pericarditis – clinical features and management
Atifur Rahman, David Liu
Case study: Michael, 32 years of age, presents to the hospital emergency department with chest pain of 4 hours duration.
Etonogestrel implants – case studies of median nerve injury following removal
Rowan Gillies, Peter Scougall, Sean Nicklin
Case study 1:
A woman, 44 years of age, presented to
a hand clinic in 2010 with a partial high
median nerve lesion, 7 days after attempted
removal of an impalpable etonogestrel
implant. During the initial removal procedure
she experienced a sudden shooting pain
down her arm, followed by paraesthesia and
dysaesthesia in her hand. The procedure was
discontinued, and she attended a hospital
emergency department.
Skin nodules with a linear distribution – a case study
Ricardo Ruiz-Villaverde, Manuel Galan-Gutierrez
Case study:
A man, 35 years of age, with an unremarkable past
medical history, attended after developing purplish
nodules on the left arm. The nodules were in a
linear distribution and had developed during recent
months after a minor initial injury. The nodules were
moderately painful, but it was mainly the appearance
of new nodules that motivated him to consult his
general practitioner.
Growing research – involving students in Cochrane reviews
Mieke van Driel
In 1992, the Journal of the American
Medical Association published a paper
launching a new paradigm for lifelong
learning in medical practice – evidence
based medicine (EBM). Twenty years
later EBM is known well beyond the
field of clinical practice and has become
an integral part of medical curricula
worldwide.
Asymptomatic bacteriuria – prevalence in the elderly population
Yohanes Ariathianto
Asymptomatic bacteriuria (ASB) is a
common condition seen in primary care
patients. This review aims to identify
the prevalence of ASB in the elderly
population and to examine its associated
risk factors, complications and natural
history, and whether treatment improves
prognosis.
Fixed dose combination diabetes medicines – usage in the Australian veteran population
Svetla Gadzhanova, Malcolm Gillies, Elizabeth Roughead, Yeqin Zuo
The number of Australians with type
2 diabetes mellitus has more than
doubled in the past 2 decades and
continues to increase. When oral
antidiabetic monotherapy does not
control blood glucose sufficiently,
guidelines recommend intensifying
therapy with a combination treatment
regimen.
Female international students and sexual health – a qualitative study into knowledge, beliefs and attitudes
Adrienne Burchard, Caroline Laurence, Nigel Stocks
International students make up an
increasing proportion of university
students in Australia. In 2008 there were
435 000 international students studying
in Australia with the largest group being
from China (22.2%). A recent Australian
survey suggested that international
students have poor sexual health
knowledge compared with local students
Motor accident insurance authority forms – a guide for GPs
David Bolzonello, Carolyn O’Shea
In each jurisdiction of Australia there is
a system to provide compensation for
persons who are injured or die as a result
of a transport accident. These schemes all
include compulsory third party cover (in
which there is coverage for injury that a
driver causes to another person due to the
driver’s actions when in a registered motor
vehicle). However, some differences exist
between the systems applicable in each
state. Some states (such as Queensland),
have a ‘fault’ based system which requires
proof of liability. This means the injured
party must be able to establish negligence
against an owner or driver of a motor
vehicle. Other states (such as Northern
Territory and Victoria) have a ‘no fault’
system. There are also variations, such as
the coverage for ‘blameless’ accidents in
New South Wales.
Preventing vascular disease – effective strategies for implementing guidelines in general practice
Bettina Christl, Jane Lloyd, Yordanka Krastev, John Litt, Mark F Harris
In Australia, The Royal Australian College
of General Practitioners (RACGP), the
National Heart Foundation and the National
Health and Medical Research Council
have published best practice guidelines
for the prevention of vascular diseases
(cardiovascular disease [CVD], diabetes, renal
disease). These guidelines include advice on
a mix of behavioural risk factors (smoking,
nutrition, alcohol, physical activity and
overweight and obesity), and physiological
risk factors (blood pressure, dislipidaemia and
impaired glucose metabolism).
Small group learning – a general practice program
Klaus Stelter, Silvana Marangoni
Continuing medical education is an
expectation of general practitioners to
maintain their vocational registration and
clinical competence. The Royal Australian
College of General Practitioners (RACGP)
has promoted the idea of lifelong learning
and there is a range of quality improvement
and continuing professional development
(QI&CPD) options available to GPs,
including large group events.
Erratum
Table 2, on page 759 of the article 'Lower urinary tract symptoms – current management in older men' by Arianayagam et al (AFP October 2011), contains an error. The contents of the left hand column of the table have been swapped so that the causes of ‘Storage symptoms’ listed are in fact the causes of ‘Voiding symptoms’ and vice versa.
Book reviews
Books reviewed this month are Examination obstetrics and gynaecology, 3rd edition by Judith Goh and Michael Flynn, Whiplash – evidence base for clinical practice by Michele Sterling and Justin Kenardy, General practice – the integrative approach by Kerry Phelps and Craig Hassed and Clinical gastroenterology – a practical problem based approach, 3rd edition by Nicholas J Talley.
Clinical challenge
Nyoli Valentine, Carolyn O'Shea
Questions for this month’s clinical challenge are based on articles in this issue. The style and
scope of questions is in keeping with the multiple choice questions of the RACGP Fellowship
exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional
Development Program and has been allocated 4 Category 2 points per issue. Answers to this
clinical challenge are available immediately following successful completion online. Clinical challenge quizzes may be completed at any time throughout the
2011–2013 triennium, therefore the previous months answers are not published.