[Summary of the practice guideline 'Lower urinary-tract symptoms in middle-aged and elderly men' (second revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Bemoeilijkte mictie bij oudere mannen' (tweede herziening) van het Nederlands Huisartsen Genootschap.

The 1997 practice guideline from the Dutch College of General Practitioners concerning lower urinary-tract symptoms (LUTS) in middle-aged and elderly men has been revised and some points have been adapted. The underlying cause of LUTS in middle-aged and elderly men is an improperly functioning voiding mechanism of the bladder associated with ageing. Symptoms are not simply due to prostate enlargement. In uncomplicated LUTS the patient's perception of the level of inconvenience is very important in considering and choosing therapeutic options. Percussion of the bladder after micturition is no longer universally advised. In general, invasive treatment is more effective in relieving symptoms than medical treatment, although invasive treatment causes more adverse effects. LUTS and prostate cancer are different entities, and LUTS is not a risk factor for prostate cancer. The issue of prostate cancer is discussed in this practice guideline in order to clear up popular misconceptions and to enhance the practical implementation of this guideline.

[Summary of the practice guideline 'Depressive disorder' (first revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Depressieve stoornis' (eerste herziening) van het Nederlands Huisartsen Genootschap.

In the revised practice guideline for the diagnosis and treatment of patients with a depressive disorder in general practice the distinction between mild and severe depression has been removed. By paying attention to a number of risk factors, the general practitioner can detect patients with a hidden depressive disorder. The general practitioner's strategy is aimed at reducing symptoms and restoring the ability to function normally. Factors that define the strategy are in particular patient's degree of suffering and dysfunctioning, and the patient's preferences and demands. In primary care tricyclic antidepressants and specific serotonin re-uptake inhibitors are the drugs of first choice: both are equally effective; the nature of the side effects differs.

[Summary of the Dutch College of General Practitioners' "Gout" Standard]. / Samenvatting van de standaard 'Jicht' van het Nederlands Huisartsen Genootschap.

The typical form of acute gout can be clinically diagnosed. The term 'complicated gout' is used if there are more than three acute attacks of gout per year, tophi or urate stones in the urinary tracts. In the case of recurrent probable acute gout, a diagnostic fine needle aspirate from the joint during an attack is indicated. First choice treatment of acute gout consists of NSAIDs. Colchicine is the second choice treatment and the third choice treatment consists of corticosteroids. Excessive alcohol use should be limited. Treatment of chronic gout depends on the uric acid excretion in the 24-hour urine. If the level of excretion is too low, the first choice should be benzbromarone, and if the uric acid output is too high, allopurinol should be the treatment of first choice. Increased fluid intake is recommended; maintenance treatment with colchicine is not advised. Consultation with or referral to a rheumatologist is indicated in the case of doubt about the diagnosis of 'acute gout' or 'complicated gout', or (suspected) bacterial arthritis and insufficient treatment effect.

[Summary of the guideline 'Osteoporosis' of the Dutch College of General Practitioners. Dutch College of General Practitioners]. / Samenvatting van de standaard 'Osteoporose' van het Nederlands Huisartsen Genootschap.

The Dutch College of General Practitioners issued a standard 'Osteoporosis' with guidelines for prevention, diagnosis and treatment in patients who have a (probably) osteoporotic fracture, who are taking at least 7.5 mg corticosteroids per day for at least six months or who have questions about osteoporosis. The core of the management is information about lifestyle (stimulation of physical activity) and nutrition. Prevention of falling is to be stimulated; sedatives, excessive drinking and smoking are to be discouraged. Persons who cannot achieve a calcium intake of 500 mg/day, patients with osteoporotic fractures and takers of biphosphonates or corticosteroids whose calcium intake is insufficient are eligible for calcium suppletion. In patients with (probably) osteoporotic fractures and those taking 7.5 mg corticosteroids per day for longer than six months preventive treatment may be considered with alendronic acid for a maximum of 3 years, if several vertebral fractures are visible roentgenologically, the T score is < -2.5 (if age < 70 years) or the Z score < -1.0 (> 70 years).

[Benign prostatic hyperplasia; recommendations for transmural care. Working Group, Dutch College of General Practitioners and Netherlands College of Urologists]. / Benigne prostaathyperplasie; aanbevelingen voor transmurale zorg.

Both the Netherlands College of Urologists (NVU) and the Dutch General Practice College (NHG) in recent years published guidelines for the management of benign hypertrophy of the prostate (BPH). The two differ in a number of respects and are not always consistent. The differences between the GP's and urologists' guidelines are mostly to be attributed to the difference in the patient populations visiting the GP and the urologist, respectively. In order to arrive a better adjustment concerning BPH patients between general practice and specialists, a team composed of NVU and NHG has drawn up 'Recommendations for transmural care'. These recommendations concern four subjects: diagnosis of micturition abnormalities, indication for examination of cancer of the prostate, drug treatment, indications for referring and re-referring of patients with micturition problems.