Plight of Afghan people must not be forgotten

Abstract

Essential simple investigations were not mentionedEditor-Urologists have spent over a decade trying to get across the message that lower urinary tract symptoms in middle aged and elderly men are not synonymous with prostatic problems. A major attempt at getting this message across was an editorial by Abrams in 1994.1 How disappointing, then, to see nocturia in a man of 68 automatically assumed to be a manifestation of prostatic disease. 2Almost the first action recommended to the general practitioner in Farmer's article is to "Show [the patient] a picture of . . . the prostate . . . and how it causes problems." The symptom described may well be due to age related changes in the detrusor, perhaps with some diminished renal concentrating power, reduced nocturnal secretion of antidiuretic hormone, and even subclinical accumulation of oedema by day and its reabsorption at night. A combination of these is at least as likely a cause of nocturia as is the prostate.No mention is made of the cheapest, simplest, and safest investigation of allcompletion of a frequency-volume chart, which often shows mild nocturnal polyuria. Nor is the measurement of urine flow rate and residual volume mentioned; this is essential and is now widely available to general practitioners through open access or nurse led clinics. No man should be given treatment until these investigations have been done.The last third of Farmer's article implies that management is mainly by blocking drugs. We have moved from an era of inappropriate prostatectomy for nocturia and other irritative symptoms by urologists to one of inappropriate pharmacotherapy by general practitioners, at massive cost. This 10-minute consultation would have been much better used to explain to the man that his presenting symptom had no more than an even chance of being due to a prostate problem and that no treatment would be considered without the essential investigations mentioned above having been done. K Baxby consultant urological surgeon All possible causes of lower urinary tract symptoms must be investigatedEditor-The assessment of a man with urinary symptoms is hard to summarise comprehensively in a single page, but Farmer's 10-minute consultation has important errors and omissions. 1 I was surprised that an article in the BMJ should use the term "prostatic symptoms" as the journal was the first to use the more correct term "lower urinary tract symptoms." 2 Studies of elderly men and women matched for age show that there is no such thing as prostatic symptoms. Abundant evidence indicates that at best there is only a weak association between individual urinary symptoms and any variable of lower urinary tract anatomy or physiology (prostate size, urinary flow rate, volume of residual urine, bladder outlet obstruction). 3For these reasons, the term lower urinary tract symptoms (which does not imply any particular pathophysiology) is more acceptable. Use of the term prostatic symptoms encourages us to forget the other pathological explanations that should be considered in the di...

Good governance must be introduced globally

“…EDITOR—With reference to the letter by Armstrong et al, like all doctors, I too regret the suffering of the people of Afghanistan 1. But I find the idea of “doctors against war” rather quaint.…”