Essential simple investigations were not mentioned

EDITOR—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.2

Almost 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 all—completion 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 α 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 …