I get burned

“First they mutilate you, then they poison you, then they burn you.”
                                            — Molly Ivins

About the time I turned forty, I started having “male trouble,” viz., prostate problems.  The gland began over-growing, making it progressively harder for me to pee—and choking down the flow enough that if I didn’t pay attention I was liable to dribble all down the front of my trousers.  That, as you might expect, was both uncomfortable and embarrassing.

The urologist I consulted gave my problem a name:  benign prostatic hyperplasia, or BPH for short.  BPH is a non-malignant overgrowth of the prostate gland, and is fairly common to occur in men as they age.  As with prostate cancer, if you’re male and you live long enough, you’re just about a mathematical certainty to get it.  As long as it’s not too advanced it can be controlled for a long time with medication, and that’s what I did.  A daily dose of a smooth-muscle relaxant named Cardura kept it pretty well in check, and I was able to live normally, although with somewhat more frequent stops at men’s rooms.

Then last year, I noticed that my symptoms were coming back, and concluded the Cardura was losing its effectiveness.  I mentioned this to the urologist, and she said she could switch me to Uroxatral and see how I did with it.  I was fine with that idea, until I read the product literature that came with the Uroxatral sample and found a warning in very bold type:  Do not take this medication if you are using the antifungal drugs ketoconazole (Nizoral, Xolegel) or itraconazole (Sporanox).  Which is a demonstration of why you should always read the product lit, because I’ve been taking Sporanox for two years now to treat my nasal polyps.  (Both of them put a strain on the liver, and both together are more than the liver can handle.)  I threw away the samples, called the doctor back and explained matters, and she changed the prescription at once to Flomax, which has many fewer drug interactions, and none with anything else I take.  At the same time, she said that since I’d shown a tendency to build up drug tolerance, I should begin to think about surgical reduction of the prostate, which would last much longer before regrowth might be a problem and would let me cut out the medicine altogether.  At first I had NO warmth for THAT idea; the classic operation for this condition, as for prostate cancer, was a (literally) bloody mess called trans-urethral resection of the prostate (TURP).  TURPs were just about a guarantee that you’d end up incontinent, impotent, or both, because there was almost no way to save the nerves that control the penis and bladder.  The doctor said “Oh, no, we’ve progressed far beyond that!”  She gave me a brochure about GreenLight, a photoselective vaporization of the prostate (PVP) procedure that uses a red laser to burn the overgrown tissue.  I agreed that I’d look at the idea, but in any case it couldn’t be done in 2007 because I had to get my nose fixed first.

Last week, when I went in for my annual urology checkup, I brought up the subject of surgery again.  The urologist said she could evaluate me as a candidate, although she didn’t do the actual procedure herself and would refer me to one of her practice partners if surgery seemed advisable.  She did an ultrasound exam and a cytoscopy; the ultrasound was fine but the cytoscopy hurt, even with lidocaine to numb me some.  Afterward I got a dose of Cipro against possible infection from having to go through the urethral wall to biopsy the prostate, and a pill for urethral pain and burning that had the side effect of turning my urine bright orange.  For a full day it looked like I was peeing Orange Crush.

The doctor looked at the results and said, “you know, at your age and given the size your prostate is (≅35 grams; normal is 20 grams), you’re a good candidate for another procedure called Prostiva (Trans-Urethral Needle Ablation, or TUNA), that uses RF energy to burn out tissue in the center of the prostate; it’s even less invasive than the GreenLight procedure.  We could do it as an in-office procedure as opposed to GreenLight, which would require you to stay in the hospital overnight.”  She told me side effects are rare; in a five-year study of people who had the Prostiva procedure, incontinence was reported at less than two percent, impotence in less than three percent, need to re-do the procedure was less than one percent, and improvement lasted throughout the study period.

That sounded like an even better idea, and the more so when I called the insurance company and they said “why yes, we’ll cover that at 100% since you already used up your deductible and annual out-of-pocket on getting your nose fixed; all you’ll have is the $30 co-payment for an office visit.”

So I called the urologist’s office again, and I now have an appointment to have the procedure done next Wednesday at 9:00 AM.  Barring complications, L will have me back home by afternoon.  I’ve asked for time off work through Friday, but my urologist said that I can go back to work as soon as I feel well enough.  The urologist who’s doing the procedure says he doesn’t use a catheter unless he just HAS to, which suits me fine.  I have no desire to struggle with a Foley cath and a bag, even for a few days.

The cross-threaded Hedy Lamarr erases some wilting I-beams in the fishpond.  Fnord.