Book Review

Urology for Primary Care Physicians

N Engl J Med 1999; 341:2024-2025December 23, 1999

Article

Urology for Primary Care Physicians
By Unyime O. Nseyo, Edward Weinman, and Donald L. Lamm. 400 pp., illustrated. Philadelphia, W.B. Saunders, 1999. $49. ISBN: 0-7216-7148-9

I review this book as a urologist who interacts with primary care physicians on a daily basis, but I acknowledge that I have definite opinions about what these practitioners should know in caring for patients with urologic disease. I also recognize that in order to write an appropriate review, it is important to understand what a primary care physician wants to know about urology, and for this reason, I asked several associates in my institution what they believed was essential. The topics they considered most important were how to evaluate a patient for urologic disease, how to treat a patient with such a disease, and when and to whom a referral should be made. Specific areas of interest included urinary tract infections, diseases of the prostate, evaluation of a patient with hematuria, preventive measures that can be used in patient care, urologic complications of medical illness (e.g., diabetes mellitus), common urologic problems in children, medications used by urologists, and urologic procedures. My review of this book is oriented toward these areas.

Urology for Primary Care Physicians, edited by two urologists and an internist, contains 31 chapters and was written by 43 authors; most are urologists, but some are specialists in neurology, internal medicine, or pediatrics. Appropriately, the book begins with chapters on the anatomy of the genitourinary system and a systematic approach to the evaluation of urologic disorders, including laboratory and imaging studies. The material presented is clear and pertinent, but unfortunate redundancies could have been avoided if there had been greater collaboration among the chapter authors or, preferably, if individual chapters had been combined. For example, a single chapter on anatomy and physical examination would have given the material more clinical relevance. In addition, much of the information on hematuria is dispersed among chapters on laboratory investigation, urologic imaging, and urologic emergencies, but quite a bit is repeated in the chapter on the evaluation and management of hematuria.

The chapters on voiding dysfunction and benign prostatic hyperplasia also contain redundant material. The authors recognize the clinical entity of lower urinary tract symptoms and also recognize that patients with benign prostatic hyperplasia not infrequently have symptoms caused by other disorders. The two chapters addressing this problem should have been combined into one to avoid redundancies. In addition, many urologists would argue that transurethral resection of the prostate continues to have an important role in the treatment of patients with symptomatic benign prostatic hyperplasia and that, for this reason, it deserves greater discussion than many of the newer procedures (e.g., laser treatment, microwave thermotherapy, and stent placement) that are still being developed. Redundancies could also have been avoided if the chapters on urologic problems during pregnancy, renal function during pregnancy, and perinatal urologic consultation had been combined and if the chapter on prostate-specific antigen had been included in the chapter on carcinoma of the genitourinary system.

Primary care physicians recognize that some patients should be referred for further evaluation and therapy, but unfortunately, in this book, the guidelines for making such referrals lack uniformity. For example, the six chapters that address infections (one on sexually transmitted diseases and the other five on upper and lower urinary tract infections in children and adults) are well done and provide useful information for primary care physicians. Indeed, many patients with these infections can be cared for by such physicians, but the authors should have emphasized which patients require more thorough evaluation and which should be referred to a specialist. I noted similar omissions in many other chapters, including those on urinary calculus disease and urologic tumors.

Despite these problems, this book is a useful resource for primary care physicians. Overall, it provides an up-to-date review of important urologic topics and information that primary care practitioners want to have. However, a greater emphasis should have been placed on prostate disease, particularly carcinoma of the prostate; more detailed descriptions of urologic procedures should have been presented, particularly with respect to associated morbidity; and most important, there should have been more specific information about which patients should be evaluated and when referral to a urologist is appropriate.

Martin I. Resnick, M.D.
Case Western Reserve University, Cleveland, OH 44106

Citing Articles (1)

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