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    Men's health: How urology and primary care can work together

    A cardiometabolic assessment is the focus of multifaceted treatment, prevention

    Martin Miner, MDMartin Miner, MD Joel Heidelbaugh, MDJoel Heidelbaugh, MD Steven A. Kaplan, MDSection Editor Steven A. Kaplan, MD

    Dr. Miner is co-director of the Men’s Health Center at The Miriam Hospital and clinical associate professor of family medicine and urology at the Warren Alpert School of Medicine, Brown University, Providence, RI. Dr. Heidelbaugh is clinical professor of family medicine and urology, University of Michigan School of Medicine, Ann Arbor. 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.

    When asked to write about the relationship between urology and primary care, we realized that the topic limited men’s health to simply a working relationship between these two disparate specialties. In our experience, men’s health is far more than the working relationship between urology and primary care centered around male-specific medical concerns, and includes several different and significant subspecialties. These encompass and are not limited to internal medicine, family medicine, pulmonology, cardiology, oncology, endocrinology, psychology, psychiatry, and geriatrics (figure).

    SLIDESHOWS: Take a tour of 4 men's health centers

    Men are referred into a dedicated men’s health center (MHC) or a clinical program for a multifaceted evaluation that includes a complete medical and urologic assessment. The focus is on a “cardiometabolic” assessment, given that the most significant causes of poor health in men are adverse cardiovascular health habits and obesity leading to metabolic syndrome and ultimately, diabetes mellitus or coronary artery disease.

    Men's health: Multidisciplinary outreachThe subsequent referrals generated from this comprehensive evaluation can be directed toward other individualized medical subspecialties or lifestyle and holistic health tutors complementing the primary care clinician’s goals of health surveillance and disease prevention. These subspecialties can then individualize referrals to the MHC for a comprehensive urologic/medical assessment when indicated. All of these evaluations and interventions are viewed as extensions of and collaborations with the patient’s own primary care clinician. These evaluations are frequently triggered by one of three conditions commonly encountered by andrology/urology:

    • erectile dysfunction
    • testosterone deficiency
    • infertility.

    These conditions are often complemented by two urologic conditions managed most commonly by primary care and can serve as a focus of an MHC:

    • BPH/lower urinary tract symptoms
    • PSA screening for prostate cancer.

    These conditions are exclusive to men, or rather the narrow lens of urologic male conditions. Together with those conditions that are not necessarily exclusive to men but are common in both the male and female population, they form the field of men’s health.

    Next: Men's gender-based medical and psychological concerns/needs

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