ABSTRACT
In general practice, lower urinary tract symptoms (LUTS) in men are usually not attributable to specific disorders. Prostate cancer is rarely the cause of LUTS. Education, counselling, and non-pharmaceutical advice form the basis for treatment of LUTS. Only when these measures do not relieve the patient's symptoms sufficiently, drug therapy could be considered. Alpha-blockers are the drugs of first choice and are also recommended when transurethral catheterization is needed for acute urinary retention. The effect of medication on LUTS is limited and largely based on placebo effect. The effectiveness of prostate cancer screening is a subject of debate; therefore patients asking for a PSA test should be informed about the benefits and harms of measuring PSA before having a test. A PSA value > 4 ng/ml, or abnormal results on digital rectal examination should prompt further diagnostic evaluation.
Subject(s)
General Practice/standards , Lower Urinary Tract Symptoms/diagnosis , Practice Guidelines as Topic , Urinary Retention/diagnosis , Adrenergic alpha-Antagonists/therapeutic use , Digital Rectal Examination , Early Detection of Cancer , Humans , Lower Urinary Tract Symptoms/drug therapy , Lower Urinary Tract Symptoms/etiology , Male , Physical Examination , Placebo Effect , Prostate-Specific Antigen/analysis , Prostatic Neoplasms/complications , Prostatic Neoplasms/diagnosis , Urinary Retention/drug therapy , Urinary Retention/etiologyABSTRACT
The practice guideline 'Peripheral facial paralysis' of the Dutch College of General Practitioners provides the general practitioner with guidelines for diagnosis and management of patients with a peripheral facial paralysis. In about two-thirds of cases of peripheral facial paralysis no cause can be found. The diagnosis of this so-called idiopathic peripheral facial paralysis is based on the patient's history and physical examination; additional investigations are not indicated. The natural course is usually good: without treatment 65-85% of patients will regain normal function of the facial muscles. Treatment with corticosteroids is recommended for all patients with an idiopathic peripheral facial paralysis, irrespective of the degree of the paralysis. This increases the chance of complete recovery by approximately 10%. Antiviral treatment is not recommended.
