Spent 45 minutes with my Uro this afternoon, when he knows its going to be a talking visit, he schedules me as his last appointment, so he's never in a hurry.
He told me about the aborted surgery. Said he had never seen such severe scarring, not only was the bladder neck closed off by scarring, but that it extend about an inch down my urehtra. He saw 2 tiny slits, and try to get the thinnest possible surgical wire through to the bladder, but couldn't do it. He said he couldn't risk cutting his way through, as there was too much chance of piercing the rectal wall, and that would have been a disaster. He said they pulled the drapes off me, and they were in the process of bring me from under, and he noticed a lot of bleeding. So he had them put me back under deep, put back on the drapes and in the end, had to cauterize where the bleeding originated. He said more scar tissue on top of the other wasn't going to make any difference. We both decided, that there would be no point in the future from every trying to go up my urehtra to the bladder.
We talked about doing the same thing, but entering through a suprapubic incision instead. He said that wouldn't work either, as since my bladder has been bypassed, its sitting collapsed (the bladder walls), and if he puncture the bladder collapsed, the hole would go clear through the bladder wall. With a working bladder, they would fill it first, then puncture just the outer wall. He described the tool as being a hollow stainless nail that they hammer through the wall, which he said was one tough muscle to get through. Again, too much risk of doing far greater damage.
He said that he won't take risks like that, or the surgery he aborted, because he's not a "cowboy", and he realizes that there is a real patient on the other end of the scapel. Told him I was glad he felt that way.
Tommorow, he is going to talk to a scan expert, and see what would be the best type of scan to examine the interior of the bladder, he will get back to me Thursday with an opinion. Then, if a scan reveals a potential problem inside the bladder, he said he could make a small open incision (not a full open op), to get access to my bladder,and then from there, he could get inside to take samples, etc in a much safer manner. I am ok with all of this.
We talked about the risk of me having bladder cancer, and still agrees that I am at high risk with all that has transpired, and that the normal means of checking are out of the question for me. Most people with a stoma/by pass like me, already had lost their bladder in the process, and that me still having a bladder with the by-pass, severely complicates his choices. Never an easy way with me about anything.
I also asked him about the best way for me to know if I have an UTI brewing or not, again, no easy answer with the by-pass. Since the urine collected reeks to begin with, you cant tell by smell, he said I would have to watch for any sign of fever, then quickly come in. They can't do conventional urine tests on me (the peeing in a cup), because of my ostomy device. It is polluted the moment a new one is put in, so they can't take urine out of it to test. If they had to have a fresh sample, I would have to lay down, have the device removed, and then they would put a foley catheter up inside the stoma (hole) deep, and draw a fresh sample from the kidneys. Nothing easy there either.
He told me he did come to see me in the recovery room but as he put it, I was too far into la-la land to communicate, after they put me under the 2nd time. I assured him I never knew he was there, nor my wife as far as that goes.
He's a good doctor and a good person to boot, we have been dealing with one another now for a bit over 5 years, and reminded me that I was one of his more difficult cases, but he enjoys the challenge.
David in SC
Post Edited (Purgatory) : 7/17/2012 6:40:37 PM (GMT-6)