By Chris Dawson, Hugh Whitfield
Urological difficulties surround quite a lot of either distressing and almost certainly lifestyles threatening stipulations and the variety of common perform shows is becoming quickly a result of expanding age of the inhabitants. either trustworthy and finished, the second one variation of the ABC of Urology offers a completely up-to-date and revised advisor to the speciality which highlights the hot advances during this sector. Concentrating in particular at the remedy and prognosis of the commonest stipulations, the emphasis is on shared care, the place the talents of the first care crew are utilized in conjunction with sanatorium referral.This concise, well-illustrated and hugely functional textual content will give you the excellent reference for common practitioners and perform nurses, in addition to junior medical professionals dealing with health facility referrals.
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Additional info for ABC of Urology (ABC Series)
An ultrasound of the bladder combined with uroflowmetry will detect a residual volume and show the flow rate profile. A tight urethral meatus in women can result in poor bladder drainage and urinary infection. When obstructive symptoms predominate, a cystoscopy and urethral dilatation may improve flow and prevent further infection. Midstream urine samples ● ● ● True urinary tract infections, rather than contaminations, are present with Ͼ 105 bacterial forming colonies/ml of midstream urine Many patients with infective urinary symptoms have lower counts Presence of more than one type of organism suggests contamination Antibiotic sensitivity testing ● ● ● This is becoming increasingly important as the number of resistant organisms increases If bacteria present on urine culture are not sensitive to the antibiotic initially prescribed, an alternative needs to be prescribed Local knowledge of the bacterial uropathogens and their sensitivity is crucial to minimising the likelihood of prescribing an ineffective antibiotic Categories of women with cystitis symptoms according to bacterial presence ● ● ● Bacteria always present in urine Bacteria sometimes present in urine Bacteria never present in urine Treatment Uncomplicated urinary tract infections usually respond to a course of three days of oral antibiotics.
Third and fourth line therapies are available, but most patients in this category will succumb to their disease. Palliative chemotherapy may be considered for hormone refractory disease. Recent guidelines suggest that patients with prostate cancer that is metastatic and resistant to hormone treatment, even if asymptomatic, benefit from treatment with a bisphosphonate, such as zoledronic acid, to reduce the risk from, and time to development of, events such as bone pain, fracture, and spinal cord compression.
In patients with asymptomatic, small volume, bony metastases, active surveillance is an option, but complications related to the cancer, such as urinary obstruction and bone fractures, are reduced in patients who take hormone therapy. Patients with advanced metastases, particularly those at risk of spinal cord compression, should be offered immediate hormone therapy. Customarily, an antiandrogen, such as cyproterone acetate, is prescribed for one week before and three weeks after the first dose of luteinising hormone releasing hormone analogue to prevent a transient stimulation of tumour growth.