Who should have a prostatectomy? A survey of the management of patients presenting with bladder outflow obstruction.

A postal questionnaire was sent to 33 urologists and to 15 general surgeons who perform prostatic surgery in Scotland. Forty-six out of 48 surgeons replied. The waiting time for outpatient consultations and waiting list statistics of the respondents were compared. Differences in access to and use of imaging, laboratory and urodynamic facilities are reported. Waiting times were affected by the individual surgeon's policy. In busy units, the desire to achieve acceptable waiting times may lead to rationing of treatment to only the most severe cases. Better provision and use of modern investigational facilities might better select those patients who will benefit most from surgical management, leading to more effective use of resources. Medical audit of surgical patients must start from the time of their referral and not confine itself to patients undergoing treatment.