Wise choices 1 in urology

Wise choices
in urology
Do not perform a bone scan on a patient with prostate
cancer when there is a low probability that the cancer has
A bone scan is used to see whether the cancer has spread to the patient’s bones.
Most patients with prostate cancer have a very low risk of bone metastasis. For that reason,
a bone scan is generally not recommended for patients with prostate cancer.
A bone scan is advised when:
• the prostate-specific antigen (PSA) level is higher than 20 ng/ml;
• the Gleason score is 8 or higher;
• the tumor in the prostate has progressed to an advanced stage;
• the patient has symptoms that may indicate the presence of bone metastases.
Do not administer antibiotics to a patient with prostatitis
without fever, unless the urine sample shows bacterial
Many men have symptoms that may look like prostatitis. When the patient has no fever, it is
not immediately necessary to start antibiotics. Research shows that a low percentage of men
with these symptoms actually have a bacterial prostate infection.
A scrotal ultrasound should not be standard practice for
boys with an undescended testicle.
Physical examination is very important in boys with an undescended testicle. A scrotal
ultrasound offers hardly any additional information. These patients should therefore not be
offered an ultrasound on a routine basis. An ultrasound may be be indicated, for example in
extremely obese children.
An abdominal CT scan should not be standard practice in
patients with microscopic hematuria.
The presence of blood in the urine may indicate the presence of a tumor in the urinary tract.
These minute levels of blood are often too small to be visible, but can be detected with a
dipstick test or under a microscope. It is possible to assess the risk of urinary tract cancer in
these patients. If the risk is low or moderate, an abdominal ultrasound may be performed.
If there is a major risk that cancer is present, a CT scan should be performed immediately.
An abdominal ultrasound or cystoscopy should not be
standard practice for recurring bladder infections.
Recurring bladder infections are a frequent problem among women. The cause of these
infections is almost never identified. An abdominal ultrasound and cystoscopy (endoscopic examination of the bladder) rarely reveal the cause. For that reason, these tests are not
recommended as standard practice.
About ‘Wise Choices’
Dutch Urological Association
Richtlijn Prostaatcardinoom [Guidelines on Prostate Carcinoma]
Richtlijn Bacteriële urineweginfecties bij adolescenten en volwassenen [Guidelines on bacterial urinary tract infections in adolescents and adults] (2009).
SWAB Guidelines on Antibacterial Therapy of Patients with Bacterial Central Nervous System Infections.
Richtlijn niet scrotale testis [Guidelines on non-scrotal testis]
Tasian G.E., Copp, H.L., Baskin, L.S. (2011). ‘Diagnostic imaging in
cryptorchidism: utility, indications, and effectiveness.’ Journal of
Pediatric Surgery. 46, 2406-2413.
Richtlijn Hematurie [Guideline for Hematuria] (2010).
These ‘Wise Choices in urology’ are part of the
‘Choosing Wisely Netherlands’ campaign. The
Dutch Association of Medical Specialists, the
scientific bio¬medical societies and the Netherlands Organi-sation for Health Research and
Development (ZonMw) aim to encourage discussions between medical specialists and patients
about healthcare options and when they are
useful or necessary.
‘Wise Choices’ are evidence-based recommendations that should be part of the doctor-patient
dialogue. These options allow doctors and
patients to define the best treatment for a
specific patient in mutual consultation.
The Federation of Patients and Consumer Organizations in the Netherlands (NPCF) is a partner
in the ‘Choosing Wisely Netherlands’ campaign.
More information about Choosing Wisely is
available on the program website