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Urology & Men's Health

 

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

 

1. PRIMARY CARE MANAGEMENT

• Describe the management of the key medical conditions which affect men.
• Manage primary contact with patients who have a male genito-urinary problem.
• Understand the role of the practice nurse in delivering effective health promotion for men.
• Understand the indications for urgent referral to specialist services, for patients with testicular lumps and suspected prostate cancer.

 

The knowledge base

 

Symptoms
• Dysuria
• Frequency of micturition
• Haematuria
• Prostatism
• Retention of urine
• Abdominal and loin pains
• Testicular lumps
• Testicular pain (orchalgia)
• Sore / painful penis, ulceration
• Erectile dysfunction

 

Common and/or important conditions
• Male-specific cancers: Testicular and prostate cancer
• Benign Prostatic Hypertrophy (BPH) and prostatitis
• Other testicular conditions e.g. cryptorchidism, varicocele, haematocele, hydrocele, epididymo-orchitis and epididymitis
• Sexual dysfunction including psychosexual conditions, premature ejaculation and erectile dysfunction
• Male contraception: vasectomy
• Male infertility
• Circumcision (religious and non-religious)
• Mental health issues including depression, suicide and andropause
• Sexually transmitted diseases (covered in detail in the RCGP Curriculum Statement on Sexual Health)

 

Investigations
• Urinalysis, MSU and dipstick
• Blood tests including renal function tests and Prostate specific antigen (PSA) test
• Semen analysis
• Knowledge of secondary care investigations including prostate biopsy and testicular ultrasound

 

Treatment
• Understand principles of treatment for common conditions managed largely in primary care – benign prostatic hypertrophy, prostatitis, sexual dysfunction, infertility etc
• Injection of anti-androgens for testicular cancer

 

Emergency care
• Acute management of testicular torsion
• Acute management of paraphimosis and priapism
• Acute urinary retention
• Acute management of ureteric colic

 

Prevention
• Health education regarding lifestyle and risk taking behaviour, sexual and mental health


 

2. PERSON CENTRED CARE
• Recognise that men may be less articulate about their health compared with women, and describe strategies to compensate for this during the consultation.
• Understand the impact of gender on individual cognitions and lifestyle, and formulate strategies for responding to this. For example, some men may have limited control over lifestyle choices, such as those from low socio-economic groups, or living with an addiction.
• Recognise that men from different cultural backgrounds have widely different attitudes towards health and expectations of the doctor. They may seem more dismissive about their symptoms than women, but be no less concerned.
• Describe the particular difficulties that adolescent males have when accessing primary care services.
• Detect whether the male patient wishes to see a doctor of the same sex and arrange this where practical and appropriate.
• Demonstrate a non-judgmental, caring and professional consulting style to minimise embarrassment of male patients.
3. PROBLEM SOLVING SKILLS

The knowledge base

 

Symptoms
• Dysuria
• Frequency of micturition
• Haematuria
• Prostatism
• Retention of urine
• Abdominal and loin pains
• Testicular lumps
• Testicular pain (orchalgia)
• Sore / painful penis, ulceration
• Erectile dysfunction

 

Common and/or important conditions
• Male-specific cancers: Testicular and prostate cancer
• Benign Prostatic Hypertrophy (BPH) and prostatitis
• Other testicular conditions e.g. cryptorchidism, varicocele, haematocele, hydrocele, epididymo-orchitis and epididymitis
• Sexual dysfunction including psychosexual conditions, premature ejaculation and erectile dysfunction
• Male contraception: vasectomy
• Male infertility
• Circumcision (religious and non-religious)
• Mental health issues including depression, suicide and andropause
• Sexually transmitted diseases (covered in detail in the RCGP Curriculum Statement on Sexual Health)

 

Investigations
• Urinalysis, MSU and dipstick
• Blood tests including renal function tests and Prostate specific antigen (PSA) test
• Semen analysis
• Knowledge of secondary care investigations including prostate biopsy and testicular ultrasound

 

Treatment
• Understand principles of treatment for common conditions managed largely in primary care – benign prostatic hypertrophy, prostatitis, sexual dysfunction, infertility etc
• Injection of anti-androgens for testicular cancer

 

Emergency care
• Acute management of testicular torsion
• Acute management of paraphimosis and priapism
• Acute urinary retention
• Acute management of ureteric colic

 

Prevention
• Health education regarding lifestyle and risk taking behaviour, sexual and mental health

Specific problem-solving skills
• Recognise that men consult less frequently and have more illness. This should lower the doctor’s threshold for suspicion of significant disease
• Utilise knowledge of the relative prevalence of all medical conditions in men compared to women to assist diagnosis.

 

4. COMPREHENSIVE APPROACH

• Identify the patient’s health beliefs regarding illness and lifestyle and either reinforce, modify or challenge these beliefs as appropriate.
• Educate men about symptoms, and the link between lifestyle and health.
• Promote well-being by applying health promotion and disease prevention strategies appropriately.
• Use consultations with infrequent attenders opportunistically for health education.

5. COMMUNITY ORIENTATION
• Describe the features of a successful men’s health service.
• Evaluate the effectiveness of the primary care service you provide from the male patient’s point of view.
• Develop practical means of engaging with men more effectively regarding their health.
• Appraise the role of well-man clinics in primary care.
• Recognise that violence and aggression is more common amongst men, assess the risk of harm to others and intervene when appropriate.
• Evaluate the arguments for and against a national PSA screening programme.
6. HOLISTIC APPROACH
• Describe the changing gender roles that men are expected to conform with.
• Recognise the importance of the parental fathering role in family structures.
• Appreciate the psychological, social, cultural and economic problems caused by unemployment amongst men.

 

 

 

 

 

All these 6 domains have a

 

7. Contextual Aspect
• Recognise important variations in men’s health according to ethnicity, social class and geography.
• Describe the local demography, social deprivation and service provision which may contribute to poor male health.
8. Attitudinal Aspect

• Recognise that relationships with male patients will be different depending on the gender of the doctor, and intervene when this is adversely affecting the doctor-patient relationship e.g. sexual advances from the patient.
• Demonstrate a non-judgmental approach towards male health beliefs, to encourage these beliefs to be expressed and modified.
• Recognise that male circumcision is important for several religious groups.

9. Scientific Aspect

• Summarise the key statistical differences between the health of men and women.