John Downes investigates underwriting considerations for urologic diseases
The word urology is derived from the Greek words for ‘urine' and ‘study of'. Another often used term for urology is genitourinary medicine or GUM for short. It is the branch of medicine that is concerned with disorders of the male and female urinary systems and the male reproductive system. Disorders of the female reproductive system come under the heading of Gynaecology.
Nephrologists specialise in kidney issues whereas urologists specialise in the urinary tract system. Urologists are trained surgeons, although they will often use non-surgical means of treatment. The urinary tract includes the kidneys so there is overlap between what urologists and nephrologists do. Although the kidneys are one of the main organs of the urinary system, many non-surgical or chronic kidney disorders are treated by nephrologists.
As September is Urology Awareness month, we thought we'd take a closer look at some of the most common urological conditions.
The three most common forms of prostate disease are prostate cancer, benign prostatic hyperplasia and prostatitis:
The prostate is a gland in the male reproductive systemabout the size of a walnut and is found just below the bladder, with the urethra passing through it. Its function is to secrete a fluid involved in the production of semen.
There are a number of diseases of the prostate gland, including cancer, with prostate cancer one of the leading causes of death in older men across the world. Over 40,000 new cases of prostate cancer are diagnosed in the UK each year, mainly in men aged 50 and above. Alongside age, both ethnicity and a family history of the disease are risk indicators.
There are often no symptoms of prostate cancer, but when they do occur they include increased frequency to urinate or difficulty in urinating. Abnormal prostate specific antigen (PSA) tests may be the first indication of the disease, but the test has been criticised for not being especially accurate.
MRI scans can be used to help diagnose the condition, however diagnosis is usually confirmed by digital rectal examination and biopsy. Almost all prostatic cancers are adenocarcinomas, a cancer that develops in the glandular tissues of the body, and are graded using the Gleason score, which is the most common system used by doctors to grade prostate cancer. This can help a doctor recommend what treatment is needed.
Treatment for prostate cancer can involve surgical removal of the gland, radiotherapy or where the cancer is in the early stage, a surveillance process called ‘watchful waiting'. Hormone based medication may be used as well.
Benign prostatic hypertrophy
Another condition frequently disclosed on insurance applications is benign prostatic hyperplasia (BPH) or enlarged prostate. BPH tends to affect men over the age of 50 and while the exact cause is unknown, it is thought to be associated with hormonal changes linked with ageing.
As the prostate enlarges, it puts pressure on the bladder and the urethra resulting in the urge to urinate more frequently or difficulty in urinating. Diagnosis is by the same methods used to diagnose prostate cancer and may also include a prostate-specific antigen (PSA) test.
BPH is not a precursor of prostate cancer and treatment for BPH depends on the severity of symptoms. Lifestyle modifications such as limiting how much you drink in the evenings may help, and medication can be used to reduce the size of the prostate. Surgery to remove the prostate is only done as a last resort.
Prostatitis is inflammation of the prostate gland, likely as a result of a bacterial infection, though often no cause is actually found. Unlike prostate cancer or BPH, prostatitis can affect men at any age, although generally it is more common in people under 50 years of age.
Symptoms of prostatitis can be similar to BPH, and pain in the pelvic or lower back regions is common. Tests to find out what's causing the inflammation are much the same as BPH, including urine tests, blood tests, and digital rectal examinations.
Prostatitis can be either acute, where symptoms develop suddenly over a short period, or chronic where symptoms persist for a longer period of time. Treatment for acute cases is usually antibiotics and painkillers. For chronic cases, additional medications may be needed to relax the prostate gland muscles.
Kidney stones is another fairly common urological condition (one in ten people in UK will have a urological stone over their lifetime). The kidneys are two bean shaped organs located towards the back of the abdomen; they remove waste products from the blood, passing them out through urination.
Waste products can sometimes build up in the blood forming crystals which can develop into hard lumps, which we call kidney stones. Small stones can be symptomless and pass in the urine. Treatment is to drink plenty of fluids, take painkillers and potentially alpha-blockers to help the stones pass. Larger stones can cause severe abdominal pain, a high temperature and sometimes blood in the urine.
Larger stones may require shock wave lithotripsy (SWL), where ultrasound shock waves are directed at the stone to break it into smaller pieces and allow it to pass. Other techniques for treating kidney stones, such as ureteroscopy or percutaneous nephrolithotomy (PCNL) will require a general anaesthetic.
Diagnosis for kidney stones is done by symptom history, as well as blood and urine tests. Those with severe pain may require an ultrasound or CT scan.
None of the above conditions, with the exception of prostate cancer, present the underwriter with any major difficulties, except where a person has unusual complications. Underwriting terms for prostate cancer, like any other cancer, will depending on the staging of the cancer, length of time since surgery and any follow up test results, and serious illness cover is unlikely to be offered.
In the case of BPH and prostatitis, assuming cancer has been discounted and the condition has been adequately treated, terms will be available for most products, possibly with an exclusion.
In the case of kidney stones, terms are also likely to be available for most products. Consideration will be given as to whether the stones are still present, whether both kidneys were affected, kidney function has returned to normal and there is no blood in the urine.
John Downes is underwriting & claims director for VitalityLife
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