  Len
Airey and Patricia live in Queensland. Australia. He was 57 when he was diagnosed
June 10, 2005. His initial PSA was 10.7 ng/ml, his Gleason Score was 7 and although
he does not state his staging it seems he was staged t1c. His choice of treatment
was Radical Prostatectomy. Here is his story.
I am writing my story because
of the help I received from the YANA website.
In early 2005 I asked my
General Practitioner for a PSA test because I had reached the age of 57. The test
came back at 10.7 ng/ml. The doctor advised that I wait for three months and then
have another test. The result showed that the PSA had increased to 11.1 ng/ml.
I was referred to a specialist Urologist.
On the 6th June 2005, I had
a biopsy of the prostate. 25% of the cores taken were positive and my Gleason
score was 7. I was advised that this was early detection and that the location
of the tumour was such that nerve sparing surgery was likely.
I was given
all the options for treatment and after discussion with the surgeon, my wife,
members of a prostate support group and consideration of alternative means of
treatment, I made a decision to have a radical prostatectomy. I had read all the
literature and that there was a 2%-3% risk of problems following surgery. The
surgeon assured me that in the previous twelve years he could count on one hand
the number of people who had had difficulties following this type of surgery.
The operation took place on the 13th July 2005 at 1.30pm. As I began coming
out of the anaesthetic, I experienced considerable pain. This continued into the
evening with doctors ultimately being recalled and staff from the Intensive Care
Unit getting involved. It was established that I was haemorrhaging but not seriously
enough to require admission to the intensive care unit. It settled down overnight
but the initial loss of blood made me very weak. The bleeding continued for ten
days.
The following days in hospital were very difficult with blood and
pieces of tissue from the operation site continuing to block the catheter and
causing serious discomfort.
The blockages persisted for the first few
days and constant irrigation was required to keep the catheter functioning. After
seven days, I was released from hospital. (By comparison, another patient who
had the same operation on the same day by the same surgeon was walking around
the hospital ward the day after the operation and left hospital on the 4th day.)
I returned to the surgeon after another week and the catheter was removed on the
27th July 2005 after two weeks. By the 16th August 2005, I was back in the hospital
having a cystoscopy because I was having difficulty passing urine. Part of the
operation site had not healed. A catheter was installed again to give the site
more time. I had difficulty with the catheter continuing to block off resulting
in me performing my own irrigation procedures.
On the 5th September 2005,
I had an X-ray which showed that the haemorrhaging had caused a sac of blood to
form on one side of the operation site with its only path for exit being the urethra.
This was the cause of the catheter blockages. The catheter was removed.
I
began passing large lumps of old blood which needed a full bladder behind them
in order to push them through the urethra. However, by the 26th September 2005,
I could not pass urine. I contacted the surgeon and was sent for an ultra sound.
The next day, 27th September 2005, I was back in hospital for further examination
under anaesthetic. There it was established that the urethral stricture was being
caused by an excess of collagen or fibrosis at the bladder/urethra join which
required dilation. My body simply wanted to close the urethra all together as
part of the healing process. A catheter was inserted during the operation and
was retained for a week. The catheter was removed on the 4th October 2005 when
I had a further cystoscopy. Following the cystoscopy, I was given a catheter with
a hard plastic end bent at about 45 degrees which I inserted everyday initially
to help keep the urethra open by force. The plan was to slowly reduce the number
of catheter insertions from daily to every second day etc. This was not the most
pleasant of experiences to say the least!
In all of this, my surgeon was
very concerned about continence - the more surgical interference with the site,
the greater the risk of damaging the tap muscle. He was very open to me seeking
alternative opinions and we arranged for another urologist to visit me in hospital.
The approach of the second doctor was much more radical. He was prepared to clean
the urethra out of all stricture and treat continence as a secondary problem to
be fixed later even if it meant the installation of a mechanical tap. No thanks!!
I continued with catheter insertions through October 2005 to February
2006 but it was becoming evident that I was fighting a losing battle. By the 19th
February 2006, the urethra was almost completely blocked. I contacted my surgeon
and was admitted to hospital at 9.30pm with the plan that he would operate again
the next afternoon. The nursing staff were unable to get a catheter into the bladder
because of the stricture. By 4am the next day, I was unable to pass any urine
at all and my operation was not scheduled until 5pm. This was one of the longest
days of my life!!
The second dilation was performed on the 20th February
but by the 10th March, the urethra had almost completely blocked again. A catheter
was inserted. By this time, the surgeon had established that no urologist in Australia
had had experience with anyone with my problems. He told me that a well respected
Urologist from the USA would be attending a Urologist's Conference in Brisbane
on the 30th March and my case would be discussed with him and other urologists.
In the meantime, I would need to keep a catheter in place. Advice was taken from
the surgeon from the US that instead of dilating the urethra, the stricture should
be incised in two places and left open.
On the 4th April, 2006, I entered
hospital again for my fourth anaesthetic and the incising of the bladder neck
was carried out. This worked well to begin with but as some weeks went by, I began
to experience a slowing in urinary flow again. By mid June 2006, it was evident
that this wasn't going to work either.
I began searching the net and although
I had been on the YANA website before reading about the experience of others and
had searched the net for "excess of collagen" as described by my doctor, it wasn't
until I typed in the words "urethral stricture" that I reached the YANA site and
the experience of Joseph Smith. Joseph had had a similar experience to mine and
had finally made some progress with a different procedure. I wrote to Joseph and
subsequent correspondence resulted in me getting the details of his procedure
and the name and telephone number of his surgeon in the USA. I had also found
information on the website of Dr. Catalona and established that everything my
surgeon had been doing was current practice for urethral stricture but just had
not fixed the problem in my case.
Armed with new information, I arranged
an appointment with my surgeon. We organised another admission to hospital and
in the meantime, he agreed to contact Joseph's doctor or at least the practice.
The stricture however, was getting worse and I was admitted to hospital
again around 9.30 pm on the 19th June 2006 but just like the previous occasion,
it was impossible for nursing staff to insert a catheter. By this time however,
I was an expert in managing catheters and asked the doctor for a hard end straight
catheter which I could force through the operation site myself to relieve the
bladder until the operation was performed the next afternoon. This was better
than waiting for 15 hours with a full bladder!!
When I fronted up to the
operating theatre, the surgeon advised that he would carry out the procedure recommended
by Joseph's doctor, which was to incise the stricture in four places and inject
cortisone into the area. The stricture had grown to 1.5cm in width and was very
hard. Although my urinary flow is not brilliant and is still being monitored,
it is now 18 months since that last procedure was performed and life is good.
What
made this journey most uncomfortable was the level of pain involved. During the
first weeks after the initial surgery, the pain I experienced was extraordinary.
Pain continued to be a problem between procedures and since. It is only three
months ago in September 2007 after more than 2 years since the initial surgery,
that I have felt free of pain and am able to sit on a chair with comfort and without
a cushion. Any aggravation of the site results in a slowing in urinary flow so
I am cautious. I don't ride bikes for example!! However, with all the prayer I
have received from so many people, I am confident that I have been healed and
will not need any further intervention.
Thanks to the YANA website and
Joseph's story, the urological profession in Australia has been further informed
on dealing with urethral stricture. I will be ever grateful to Joseph and YANA
for publishing his story and the experiences of other men around the world and
would be delighted to discuss my experience with anyone interested.
Six
monthly blood tests since the initial operation have revealed no trace of cancer
and my erection function is slowing improving.
Len's e-mail address is:
lpairey@bigpond.net.au
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