Other urologic conditions. Outside of urologic oncology, depression has been linked to several other urologic conditions in both men and women, such as renal stone disease, urinary incontinence, and lower urinary tract symptoms secondary to BPH. In children, those with voiding dysfunction or enuresis may have a higher rate of psychosocial difficulties. Some medications may also be linked to depression, with research showing a higher risk of depression among women with overactive bladder who are treated with anticholinergic drugs (vs. those who are untreated) and among men who are treated with 5-alpha-reductase inhibitors.
Mental wellness weaves itself into many different medical conditions, and urology is no exception. Among urologists who treat cancer patients, it is particularly important to recognize the importance of psychological health after diagnosis and treatment. An assessment of the patient that goes beyond the most recent post-treatment PSA level is also important to a patient’s survival, and for the busy surgeon, establishing a multidisciplinary network of related health care professionals should be a priority. Being able to offer patients hope and therapeutic options for consequences of cancer treatment can provide them with optimism and options. Examples include referral to a colleague who can offer surgical options such as an artificial urinary sphincter or penile prosthesis and referral to a sex therapist who can teach couples about intimacy after cancer.
Survivorship has gained increased importance, and the American Cancer Society prostate cancer survivorship care guidelines highlight this issue (CA Cancer J Clin 2014; 64:225-49). If a urologist is faced with a patient who he or she believes may be at increased risk for suicide, it is critical to ask about suicidal ideation and plans. In this situation, further questions about the proximity and details of these plans are necessary. Based on the person’s answers, and especially in a patient who communicates an explicit intention to die, an emergent referral to a psychiatrist is necessary.
Section Editor Steven A. Kaplan, MD, is professor of urology, Icahn School of Medicine at Mount Sinai, New York.