© The Canadian Journal of Urology™; 21(3); June Supplement 2014
Address correspondence to Dr. Jack Barkin, Department of
Surgery, University of Toronto, 404-960 Lawrence Avenue
West, Toronto ON M6A 3B5 Canada
A guide to the management of urologic
dilemmas for the primary care physician (PCP)
Jack Barkin, MD,
1
Matt T. Rosenberg, MD,
2
Martin Miner, MD
3
1
Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
2
Mid Michigan Health Centers, Jackson, Michigan, USA
3
Departments of Family Medicine and Urology, Miriam Hospital, Brown University, Providence, Rhode Island, USA
BARKIN J, ROSENBERG MT, MINER M. A guide to
themanagement of urologic dilemmas for the primary
carephysician (PCP).
Can JUrol
2014;21(Suppl 2):55-63.
Patients with urologic conditions may present to a primary
care physician (PCP) in the emergency department or in
the PCP’s office. Some conditions are true emergencies
that require immediate surgical intervention. Others may
require medical treatment or possibly simply reassuring
the patient that there is no serious medical problem.
Sometimes the diagnosis can be easily made, whereas
other times the PCP needs to be able to rule out serious
causes for a presenting problem and execute a guideline-
recommended patient work up, to make a final diagnosis.
Sometimes recommended diagnostic tests may not be
readily available. When a PCP believes that a patient
may have a serious urologic condition and is unsure of the
appropriate patient management strategy, then he or she
must quickly refer the patient to a urologist. This article
describes common urology-related issues—hematuria,
prostate-specific antigen (PSA) test interpretation,
phimosis and paraphimosis, acute scrotal pain and
masses in the child and adult, urinary tract infection,
renal colic, and castration-treatment-induced bone loss.
It provides insights into decision-making processes for
patient management of some urologic conditions, and
information about managing sequelae and side effects
of long term treatment. It includes practical diagnostic
suggestions and patient management strategies based on
the authors’ years of urologic clinical practice experience.
Key Words:
urologic dilemmas, management,
primary care physician
related issues--hematuria, prostate-specific antigen
(PSA) test interpretation, phimosis and paraphimosis,
acute scrotal pain and masses in the child and adult,
urinary tract infection (UTI), renal colic, and castration-
treatment-induced bone loss.
Urologic dilemmas
Hematuria
Hematuria is the presence of red blood cells (RBCs)
in the urine. In addition to being red from blood
cells, urine may be red after a patient eats beets or
ingests red dye from pills or food. A patient work
up for hematuria, as with other medical-condition
work ups, is usually accomplished by obtaining a full
patient history, a complete physical examination, and
laboratory investigations.
Introduction
Patients may present to a primary care physician
(PCP) in the emergency department or in the PCP’s
office with a variety of urology-related conditions.
Sometimes the diagnosis can be easily made, whereas
other times the PCP needs to be able to rule out serious
causes and execute a patient work up to make a final
diagnosis. When a PCP believes that a patient may
have a serious urologic condition and is unsure of
the appropriate patient management strategy, then
he or she must quickly refer the patient to a urologist.
This article provides insights into common urology-
55
