Right to a referral

Does a patient have any rights regarding a refusal to grant a referral.
I have been refused my Urethraplasty referral request by my Urologist.
This request was made under the treatment abroad scheme (I'm in Europe).
After two previous Urethrotomys for bladder neck strictures within 6 months of RP , I wanted to discuss Urethraplasty as an option in case this daily dilation (past 8 months) of the stricture fails.
My Urologist stated after the last Urethrotomy that a third one would risk incontinence.
In the past my complaints about urinary retention symptoms were ignored until Urethrotomy was the only option left, so I'm trying to avoid a repeat.
Does he have the right to refuse my request as he just said it would mean ondoing an already difficult procedure.
The application can only be made by my practising Consultant.

River Road said...
Does a patient have any rights regarding a refusal to grant a referral.
I have been refused my Urethraplasty referral request by my Urologist.
This request was made under the treatment abroad scheme (I'm in Europe).
After two previous Urethrotomys for bladder neck strictures within 6 months of RP , I wanted to discuss Urethraplasty as an option in case this daily dilation (past 8 months) of the stricture fails.
My Urologist stated after the last Urethrotomy that a third one would risk incontinence.
In the past my complaints about urinary retention symptoms were ignored until Urethrotomy was the only option left, so I'm trying to avoid a repeat.
Does he have the right to refuse my request as he just said it would mean ondoing an already difficult procedure.
The application can only be made by my practising Consultant.

Has your treating physician already referred you to a particular urethraplasty surgeon? And your insurance is denying payment? Or...is it more "generic" than that? As in...your treating physician has asked if they will pay for one in general and they're saying "no"?

If you have a particular surgeon in mind, he may have run into this before and he might know of a way around this.

There is also an appeals process with my carrier. At first...they denied my request for Proton therapy. A second appeal was also denied. On the 3rd appeal it was approved. Sometimes these guys know how to word things in such a way...(I would not have known how to do this on my own. The Proton guys took care of all of all of it. Of course, they're pros at this).

Could you pay for just a consult with a plasty surgeon to see what they have to say about both your case and the ins. problem? They may know something about how your treating physician needs to proceed.

(I've had a bit of a stricture myself. My only dilatiin was May 18th. So I've been following your journey).

Hi David,
Thank you for your comments.
I should have stated it is a referral abroad under the public health system.
Yes, my urologist had arranged the appointment with the Urethraplasty specialist but he ensured the application for health service approval got refused by stating treatment was available without going abroad.
He stated that over a 20 year period he had four cases of patients with recurring bladder neck strictures and they became stable after four years.
The timeline seems to have changed as I was told dilation for about one year.
My only reason for seeking the urethraplasty appointment was just to have a second option.

If I first see the urethraplasty specialist privately the health service will then refuse any future application to see him
as they would deem me to be a private patient of that specialist.

I mean does my Urologist have the right to refuse my referral request when all he can offer is self dilation and in the event of the stricture closing again a further (3rd) urethrotomy which he has already stated risks incontinence.
I will ask the urethraplasty specialist has he a work around on the referral.
Yes, I will appeal the decision.

May not be the same but I had to get a referral to see an oncologist from another health plan and they approved it just to see him but getting treatments is another story. Its all about money. How much will the treatment cost the plan and do they have someone in house that can do it or do they deem that it is necessary. Good luck

It depends on where you are and the health care provisions you have. You say you are in Europe...where? Certainly for us in the US we can not advise you as our laws have nothing to do with other countries. If you believe you are not being treated correctly then you need to seek local legal counsel.

It's good to hear from you. I'm glad you got into see him. Keep the news coming. What you're dealing with is either very rare or not so rare but not talked about that much. It's difficult to find information on this from where you are in your journey. I think it's good to have it on here.

Lots a reasons it good to have it on here. Feels lonely when you can't find others that's been there done that. People....whose looking.... can find this....see what others are doing...have done....etc

From what I've read....you get one shot at it. If that's not a keeper....further instrumentation is palliative only. My thinking is....if mine were to close up to less than 14 fr.....and I can still pee....I'd roll with it and not poke a sleeping bear. I figure if anybody really had to get in there....they would. I'll take my chances.


Even if you quit dilating.....it may not close up all the way. That's something you might want to run past your uro or the other surgeon and get their take on it. They may neither one know what would happen. And you may or may feel comfortable with such a plan.

Hi David, good to hear from you too.
Yes, dilation is best and another Urethrotomy is an option if needed, but I would get metal sound dilation done first at an early stage. I don't see the point in Urethraplasty in my case at this time when sphincter damage is the outcome.
I originally thought sphincter damage was only a possibility.
The main cause of the stricture after open RP seems to be either the stitching was too tight or urinary leakage at the join.
My urologist said it was because I heal too quickly.
Another Urologist said that a stricture was less likely to happen with robotic RP due to the magnification ...I guess that means you are also a rare case
I agree recurring strictures seem to be uncommon ..perhaps I should have posted this under a separate topic.
One Urologist stated that he has patients happily doing daily dilation for years ..not sure how you happily do that!
I find the stricture is tighter after a week compared to daily dilation so I think it would be risky for me to stop as the stricture has closed twice already. The symptoms were lower back pain and painfull urination for 3 or 4 weeks prior to it closing.
Congrats on your successful Urethrotomy. To ease your mind I was having urinary retention symptoms two weeks after the RP and Urethrotomy. Dilation only started after the second Urethrotomy.
James