Acute urinary retention: developing an A&E management pathway.

Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalisation, catheterisation and often surgery (Kirby, 1998). AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. The management of AUR is highly dependent on the cause, mainly BPH and clot/haematuria. Medical management will often necessitate the insertion of a urinary catheter, a procedure which is associated with an increased risk of urinary tract infections (Mulhall et al, 1998). The use of alpha-adrenegic antagonists (alpha-blockers), 5-alpha-reductase inhibitors, a trial without catheter and the catheter valve are recommended to delay or prevent the need for surgery and future complications. Proper assessment and documentation, particularly in relation to the catheterisation process is of vital importance. The authors demonstrate how audit was used in the development of a management pathway to provide guidance to accident and emergency (A&E) practitioners in their delivery of care to patients who presented to the A&E with AUR.

A questionnaire study of GPs' and patients' beliefs about the different components of patient centredness.

Much research has explored the interaction between doctor and patient in the consultation and patient centredness has generally emerged as the preferred mode of consultation style. The present study aimed to examine and compare general practitioners' (GPs) and patients' beliefs about the importance of the different aspects of patient centred behaviour in a consultation. Matched questionnaires were completed by 410 patients (response rate=76.5%) and 64 GPs (response rate=85.3%) from practices around London concerning aspects of patient centredness operationalized in terms of doctor receptiveness, patient involvement, the affective content of the relationship and information giving. The results showed that GPs and patients showed similar beliefs about involving the patient in decision making, aspects of doctor receptiveness and the importance of the patient's own feelings in the consultation. However, GPs believed that it was less important to focus only on the patient's main problem, and more important to acknowledge their own feelings and avoid medical language. Further, GPs rated doctor receptiveness and the affective content of the relationship overall as more important for a good consultation than the patients. The patients also consistently rated information giving as more important than the GPs. To conclude, GPs rated the doctor receptiveness and affective components of patient centredness as more important than patients whereas patients showed greater endorsement of information indicating that although patient centredness may currently be the preferred style of consultation, doctors and patients prefer different aspects of this behaviour.

Interleukin-8 levels in seminal plasma in chronic prostatitis/chronic pelvic pain syndrome and nonspecific urethritis.

OBJECTIVE: To investigate whether a range of cytokines were detectable in the seminal plasma and urine of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and nonspecific urethritis (NSU), and whether cytokine levels correlated with symptom severity in CP/CPPS. PATIENTS AND METHODS: In all, 87 men participated, 33 with CP/CPPS, 31 with NSU, and 23 controls. Interleukin (IL)-1beta, IL-2, IL-6, IL-8 and IL-10 were measured in seminal plasma and first pass urine, and the results were correlated with scores for pain, urinary symptoms and quality-of-life impact using a validated symptom index, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). RESULTS: Seminal plasma levels of IL-8 were higher in men with CP/CPPS and NSU than in controls (P < 0.001), and the levels correlated with NIH-CPSI symptom scores in men with CP/CPPS. There were no significant differences in urinary IL-8 levels in the three groups, and no significant differences in levels of the other cytokines in either semen or urine. CONCLUSION: Semen IL-8 levels correlate with subjective symptoms in men with CP/CPPS. IL-8 might contribute to the pathophysiology of CP/CPPS and NSU, and elevated levels might be a useful marker of the condition.

Pilot study of testicular cancer awareness and testicular self-examination in men attending two South London general practices.

BACKGROUND: Testicular cancer (TC) awareness and testicular self-examination (TSE) have never been evaluated adequately in UK general practice. TC has a 96% cure rate if detected early. OBJECTIVES: Our aim was to estimate awareness of TC and practice of TSE in a general practice population. METHOD: A cross-sectional questionnaire survey was carried out in 250 consecutive male attenders aged 18-50 years in two general practices, one inner city, and one suburban. After obtaining informed consent, male patients in the waiting room were asked to complete a brief confidential questionnaire about TC and TSE. RESULTS: The response rate was 81%. Mean age was 32 years (range 18-50). Seventy-five per cent of responders described themselves as white, 12% Asian, 6% black and 7% other ethnic groups. Ninety-one per cent were aware of TC but only 26% knew both the age group most affected (25-34 years) and that TC can be curable if detected early. Although 49% of responders had carried out TSE in the past year, only 22% were practising according to recommendations: feeling for lumps at least monthly. TSE was associated with age >35 years, white ethnicity, knowing someone with TC, having attended a Men's Health Clinic and having heard of the 'Everyman' TC awareness campaign. CONCLUSION: Although awareness of TC in this GP population was reasonable, less than half were practising TSE. Further public health campaigns may be needed.