A few observations on the development of this thread!
What happened to the chaperoning bit?
Apologies for the fragmentation - lost me logarithms :-)
IMHO
Patients don't present with "prostate" symptoms but rather
symptoms of urinary outflow obstruction.
The findings on PR are not likely to influence one's
decision to refer for symptom relief.
Surgery is indicated only to relieve obstructive symptoms or
to prevent or relieve hydronephrosis in chronic urinary
retention.
PSA does not meet the criteria for a perfect screening test
but has been portrayed as such by the media and our
patients (and us) find a normal result reassuring. There is
no doubt that a markedly raised result will generate an
urgent appointment.
When one refers to one's matey local Urologist with all
one's findings, history, exam, Ix, etc. one then finds them
all reiterated in the SHO's response along with his/her
intention to repeat most or all and review in x months.
I feel that it is this type of response which does most to
damage our professional pride. Isn't it much nicer to get
back a letter like:
"Thank you for referring this chap. I agree with your
findings and appreciate you arranging the necessary tests. I
have organised a cystourethroscopy and ?TUR."
As most contributors have written - the management of this
problem is largely based in the secondary sector but I
will concede that in the face of minimally disruptive
symptoms then a normal or benign feeling prostate with
normal renal function, U/S and PSA might prevent a
referral for Surgery.
Peter
Dr Peter Wilson The Mockett's Wood Surgery
Medical Manager Hopeville Avenue, St. Peter's
East Kent Doctors On-Call Broadstairs, Kent, CT10 2TR
Kent International Airport Telephone 01843 862179
Manston, Kent, CT12 5BP Fax 01843 823046
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