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I've had retention problems for some time, without it seeming to be a problem: about 500 - 600mL. But about a year ago my blood pressure started rising, eventually to alarming levels (200+/105). Then my remaining kidney started showing signs of reduced functioning - creatinine levels up, eGFR down (eventually 25). Various specialists investigated and put me on various blood pressure pills, which worked to some extent, with unpleasant side effects. Eventually I had an ultrasound check of my abdomen, which showed dilated ureter with what seemed to be an obstruction. So a cystonephroscopy was done (a visual check, via the urethra, into the bladder and ureter).
They found (a) some low gade baldder cancer; (b) no cancer in the ureter, just distension; (c) high urine retention (1.2L). They put a catheter in for me to drain regularly and thus relieve the back-wash into the ureter (which may have been causing the poor kidney function and increased blood pressure); this to remain until I had a TURP in several week's time.
Subsequently, my kidney function improved and my blood pressure fell (I've halved my hypertension medication too). This shows that the earlier consultations with the hypertension people failed to discuss or test for this possible cause (I'd been put on an increasing dosage and wider variation of pills instead). and thus didn't uncover this cause and more productive way.
Next, I found the poor sleep and lack of sex with the catheter such that I didn't want to wait months with it in. Fortunately, I can afford to go private. This didn't produce the rapid response from the local team that I hoped for - failure of communication and missed clinics. I started a hunt for alternatives, meanwhile chiving up the locals (which eventually got a response, but after I'd found someone else to do it quicker and cheaper).
I got a bewildering and conflicting set of recommendations from experienced urologists - TURP, Green Light Laser, HoLEP, UroLift. All seemingly sincere and stating that their preferred option was the best. Even contradictions: one urologist said as I'd had bladder cancer, then a couldn't have UroLift; an hour later another urologist contradicted that but then thought surgical TURP was the best even though he did HoLEP and UroLift. Etc.
In parallel with all this, I was attempting to find a hospital that has a short waiting time for this op on the NHS. Theoretically, and English patient can choose to go to any hospital. But try finding a list of hospital waiting times for this op (or any other for that matter) as I did, and I found nothing. I failed after three days searching the web, and phoning various organisations (NHS Choices, CCG, BICS, PALS, hospitals direct): either nothing or having the same waiting times for the one or two hospitals I talked to directly.
My conclusion from this is that there may not be much difference in outcome on average from any of the alternatives, and the expertese and experience of the urologist along with the patient's individual situation may have more of a bearing on the outcome than any one of the four alternatives.
So I feel now relaxed that I'm having my op done next Tuesday, by HoLEP, with a surgeon who says he's been doing two a week.
I'll report back afterwards.
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