Integrative urology: a spectrum of complementary and alternative therapy.

T accustomed to rapid resolution of urologic disease by surgical or endoscopic procedures, urologists have only recently begun to apply complementary and alternative methods to patient care. With the concurrent shift toward an office-based process of care, urologists have responded to patient-driven trends toward wellness, self-healing, and nutraceutic and phytotherapies and have recognized the relevance of complementary and alternative medicine (CAM) to urologic practice. Unique to our specialty, urology is comprised mostly of quality-of-life issues: benign prostatic hyperplasia (BPH), prostatitis, voiding dysfunction, erectile dysfunction, and cancer prevention and survivorship, fields particularly amenable to CAM treatment strategies. In sequential studies, Eisenberg and colleagues1,2 demonstrated a 30% increase in the use of alternative therapies and a 47% increase in the total number of visits to alternative medicine practitioners between 1990 and 1997. Parallel trends have also prevailed in urology, as evidenced by the burgeoning reports of alternative therapy for BPH3 and prostate cancer4 and the recent establishment by the American Urological Association of a Committee on Complementary and Alternative Medicine. On a national level, the 1998 Omnibus Reconciliation Act upgraded the former Office of Alternative Medicine to the National Center for Complementary and Alternative Medicine by tripling its budget. In this review, CAM applications are presented, with caveats for practitioners integrating CAM into conventional urologic practice. The resultant field of Integrative Urology more closely conforms to patient preference and to future practice paradigms for the urologist. PRINCIPLES OF INTEGRATIVE UROLOGY