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The Urological Ten Commandments

Capture“It is my ambition to say in ten sentences what others say in a whole book.” – Friedrich Nietzsche

The EAU guidelines on lower urinary tract symptoms have been published recently.  These contain 36,000 words.  It was pointed out to me that the American declaration of independence contained 1300 words and The Ten Commandments just 179 words.

The challenge was therefore to write ten commandments for urology in 179 words.  The rules I set were that I should write them whilst keeping  the spirit of the structure of the decalogue as closely as possible.  (It may be worth rereading the original before reading on).  So here goes.

1) I am a logical specialty. Thou shall investigate thoroughly prior to undertaking intervention for I am a specialty that avoids surprises.
2) Though interested in the whole of medicine thou will perform no other procedures other than urological.
3) Thou shalt not base intervention on old imaging for the clinical situation could have changed.
4) Remember that 80% of diagnoses can be made with history alone.  Thou shalt listen carefully to your patient to this end.
5) Honour sound surgical principles.  Urological tissue is forgiving but anastamoses under tension will not heal.
6) Thou shall not ignore haematuria.
7) Thou shall not leave a stent and forget it has been placed.
8) Thou shall not adopt new technology without proper clinical evaluation unless it is part of a trial.
9) Thou shall not fail to see the images yourself in assessing the patient before you.
10) Thou shall not fail to assess the potential for harm before embarking on a surgical procedure. If you would not do it to your family, your neighbour or friends, you will not do it to the patient who is in your clinic.

I put these out for discussion.  Other offerings please.


Jonathan M. Glass @jonathanmglass1

The Urology Centre, Guy’s Hospital, London, UK.   

[email protected]


3 replies
  1. James Brewin
    James Brewin says:

    Fantastic work. I think number 8 should read: Thou shall not adopt new technology without proper clinical evaluation unless it is a robot!

  2. Ben Challacombe
    Ben Challacombe says:

    Great stuff
    how about Retention doesn’t equal BPH
    Colic doesn’t equal stone
    Infection and obstruction is urgent danger
    Its never too early to send
    and you can never have too much lubrication
    come on everyone- too many Lurkers out there and need more comments!

  3. Garrett Durkan
    Garrett Durkan says:

    Great post.
    How about ‘hydronephrosis does not always need a stent’;
    ‘vomiting with acute scrotal pain indicates torsion’
    ‘look under the scrotum or you shall miss Fourniers’

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