By Chris Dawson, Hugh Whitfield
Urological difficulties surround a variety of either distressing and probably existence threatening stipulations and the variety of normal perform shows is turning out to be swiftly a result of expanding age of the inhabitants. either trustworthy and complete, the second one variation of the ABC of Urology presents a completely up-to-date and revised consultant to the speciality which highlights the hot advances during this zone. Concentrating particularly at the remedy and analysis of the commonest stipulations, the emphasis is on shared care, the place the talents of the first care group are utilized in conjunction with health center referral.This concise, well-illustrated and hugely functional textual content will give you the ideal reference for normal practitioners and perform nurses, in addition to junior medical professionals dealing with health center referrals.
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In ill patients, nephrostomy drainage is preferable. The cause of obstruction can be dealt with at a later date, when the sepsis has resolved and the patient is well again. 24 Most cases of upper urinary tract infection are caused by Gram negative bacteria, predominantly Escherichia coli. qxd 7/7/06 4:46 PM Page 25 7 Prostate cancer Chris Dawson Percentage of change Epidemiology Prostate cancer is the most common cancer in men in the United Kingdom and accounts for 20% of cancers in men overall but only 13% of deaths from cancer in men.
A plain x ray of the kidneys, ureters, and bladder and a renal ultrasound examination will exclude upper tract abnormalities including stones. 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.
Similarly, the amount of prostate specific antigen bound to protein (complexed prostate specific antigen) can be measured. Complexed prostate specific antigen is more stable in extracted blood samples and may give more reliable results than levels of free prostate specific antigen. 5 ABC of Urology Second Edition Edited by Chris Dawson and Hugh N Whitfield © 2006 Blackwell Publishing Ltd. ISBN: 978-1-405-13959-5 Localised disease Options: Active surveillance Radical prostatectomy External beam radiotherapy Brachytherapy Locally advanced Options: Radiotherapy with or without hormone therapy Metastatic Options: Active surveillance if small metastases Hormone therapy Diagnosis and management of prostate cancer Counselling patients who request a prostate specific antigen test ● ● ● ● ● Although the test for prostate specific antigen itself is innocuous, the consequences of an increased level of prostate specific antigen may be more considerable A level of prostate specific antigen higher than the age specific reference range requires a transrectal ultrasound and biopsy of the prostate, as long as no contraindications exist The biopsy procedure has known complications of haematuria, haemospermia, and rectal bleeding.
ABC of Urology (ABC Series) by Chris Dawson, Hugh Whitfield