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    Men’s health: The argument for a holistic approach

    It’s time to look beyond ‘pelvic care’ and refocus our efforts on male patients’ needs

    Steven A. Kaplan, MDSteven A. Kaplan, MD

    Dr. Kaplan is E. Darracott Vaughan Jr. Professor of Urology at Weill Cornell Medical College and director of the Iris Cantor Men’s Health Center, New York Presbyterian Hospital, New York. Follow him on Twitter at @MaleHealthDoc.

    Over the past decade, we have begun to hear new terms to describe how we should categorize health care delivery. Among those terms are personalized health, eg, genomics, pharmacokinetics, and gender care (ie, women’s and men’s health). They all sound sophisticated and very 21st century, but what do they really mean to the average practitioner and patient? More specifically, urologists have become increasingly interested in men’s health. Not surprisingly, this has met with some skepticism as a branding effort rather than a new paradigm of health care delivery.

    But is there an opportunity for the specialty of urology to refocus our educational and practice efforts to a more holistic approach that caters to the needs of men? I would enthusiastically answer, yes! Moreover, if we don’t, urology is in danger of falling behind as an optimized specialty in health care delivery for men.

    To that end, Urology Times has embarked on the development of #LetsTalkMensHealth, a novel new section focused on men’s health, and I am excited to act as the lead of this endeavor. So what is men’s health and why now?

    Why men’s health now?

    Patients who suffer from various aspects of metabolic dysfunction are overwhelming the health care system. In large part, this is due to the crisis of obesity, which is related and secondary to decreased exercise, poor diet, and the cumulative effects of environmental stress. Obesity is an enormous public health problem in the U.S. and worldwide, and is associated with numerous comorbid illnesses and chronic conditions. This is coupled with escalating cost and significantly impacts the quality of life in affected individuals.

    Chronic diseases associated with obesity include type 2 diabetes, heart disease, sleep disorders, musculoskeletal pain disorders, and cancers of the colon, esophagus, gallbladder, and kidneys. Type 2 diabetes is approximately four times more prevalent among obese men, and twice as many have high cholesterol or heart disease compared to normal-weight men.

    Moreover, associated urologic disorders, including benign prostatic hyperplasia, hypogonadism, erectile dysfunction, prostatitis, and nocturia are all more common in obese men.

    These findings represent an important entry portal for urology and urologic care. We have to start thinking above the waist in a systematic function to bring greater value to the health care system at large.

    In other words, men’s health should focus on the unique health needs and accompanying services that must be implemented to address this phenomenon. Chief among these needs is a gender–specific approach (this applies to women’s health as well) that encompasses and affects change in research, advocacy, government policy, and allocation of resources. Ultimately, this is all designed to optimize health services delivery.

    In a previous summary of the topic, Elterman et al summarized the concept of the leadership role of the urologic community: “We need to be at the forefront in defining the issues, ‘connecting the dots,’ collaborating with stakeholders to create initiatives, and integrating those practices into the field in order to broaden the definition of the Urologist as the Men’s Health physician” (Nat Rev Urol 2013; 10:606–12).


    Next: Focus has been on specific organs rather than holistic approach


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