Management is more complex issue than was described

EDITOR—Emberton and Anson's review of acute urinary retention was timely and informative.1 In part of it they focused on the use of finasteride to reduce the risk of the disease.2 We disagree with them that the continuous administration of finasteride for four years is probably warranted in men with large prostates, moderate to severe symptoms, and poor urinary flow rates.

Firstly, the cost implications are enormous. To prevent one event (acute urinary retention or prostatectomy) 15 patients would have to be treated for four years at a cost of £19 475.3 Secondly, the reduction in mean symptom scores with long term finasteride treatment is small (mean reduction 3.3 points) and not comparable with …