Objective To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation. Patients and methods A retrospective questionnaire was sent to 100 patients who had undergone transrectal biopsy between January and August 1998. Levels of patient acceptability and satisfaction were assessed using visual analogue scales (VAS, with a maximum score of 10 being the least satisfactory or acceptable) and direct questions about the side‐effects of the procedure. A subsequent prospective study was undertaken on 130 patients undergoing transrectal biopsy with sedation between January 1999 and January 2000. Results The mean score for patient discomfort with sedation was 1.5, compared with 3.5 with no sedation. The overall satisfaction score improved from 3.1 to 0.9 with sedation. Complication rates were comparable, although slightly higher overall in the prospective group. Conclusion Sedation can significantly reduce patient discomfort and make the transrectal biopsy a more satisfactory experience for the patient. This is particularly important in the proportion of men who need to be considered for repeat biopsies.

BPH, the most common benign tumour that affects men, is a disease that mostly causes morbidity through its associated LUTS. Symptom indices are instruments that allow the objective measurement of these symptoms. Analysis of the data they provide allows symptom severity to be measured and the changes that occur in symptoms with time to be monitored. Measurement of symptom severity and assessment of disease progression are important parameters when treatment decisions are being made. After treatment, measurement of LUTS using symptom indices allows efficacy to be judged as well as providing an ongoing assessment of patients. Data from symptom indices allow patients to be compared with each other and may provide useful epidemiological information when groups of patients are assessed. However, it should be stressed that symptom indices are not reliable for screening populations for disease and should not be used for case-finding. Many new treatments for BPH/BPO are being developed and assessed in clinical trials. The measurement of symptoms using symptom indices has had a central role in these trials and will continue to do so. A considerable volume of published work presenting data from these trials is now accumulating. Comparing new treatments with the 'gold standard' of TURP is facilitated by symptom indices, as is the comparison with other novel modes of treatment. The AUA-7 index remains the best scientifically validated index used in patients with symptomatic BPO, although other indices, e.g. the Boyarsky, Madsen-Iversen and MMAP, when compared with the AUA-7 have been found to perform similarly. However, it would be preferable if the validation process of current indices included validation against pathophysiological processes such as proven BOO and detrusor instability. The current use of symptom indices will add to data supporting their reliability and validity. It is to be anticipated that symptom indices will be used increasingly both in clinical practice and clinical trials and that trust will be placed in the data they provide. It is essential that the limitations of these indices are borne in mind, and that the indices are applied correctly so that the information they produce remains valid and reliable.

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