WARNING! THIS DOCUMENT IS FOR ADULTS ONLY

IT USES PLAIN LANGUAGE REGARDING SURGICAL

PROCEDURES AND BODILY FUNCTIONS

My TURP

I became acutely aware of my prostate about twenty years ago when I had an infection that put me in the hospital for 5 days. I had had a "flu" and was taking "Isochlor Timesules", an antihistamine that exacerbated the problem. I realized that I was in deep trouble when I discovered that I could not pee.

After 7 hours of excruciating pain I finally got admitted to a hospital and received my first catheter. The orderly that inserted it into my penis inflated the "ball", then turned to get something and in doing so managed to jerk the catheter out of my penis. After the second insertion I was so miserable that I didn't think I would ever feel worse. Boy, was I wrong!

Over the next 5 days I suffered an antibiotic induced migraine and entered into a war with nurse Ratchet when I got my brother-in-law doctor to allow me some ice cream. While in the midts of one such migraine she subjected me to a deranged screaming admonision that I never go over her head. what a bitch!

Over the last twenty years since, my prostate has continually grown, causing me up to 12 visits a night to the toilet. Also, for the last ten years I could never go anywhere without planning where I was going to pee next. I took Proscar for five years, Saw Palmetto, and a myriad of other totally worthless drugs, the names of which I have since forgotten.

Over the years, various doctors had suggested having the "roto-rooter" treatment. My father had had that operation years ago, and he had told me before he died that he had dribbled pee the rest of his life and that after the operation he never had another erection. Safe to say, I was not anxious to follow his path.

I had pretty much acclimated myself to having my prostate rule every aspect of my life. The most urine I could excrete at one time was 120 ml on a good day. Also, I had experienced enough nocturia that I wore a depends pad to bed for the last ten years. Then in January, 2001, I discovered what appeared to be a third testicle in my scrotum.

Scared, but resigned to what I self diagnosed as possible testicular cancer, I was relieved to find that the mass was not opaque, but would allow light from a penlight to pass through it. I went to the doctor, who diagnosed it as a "communicating hydrocele". Told it would resolve itself, I went home with instructions to avoid heavy lifting.

At first, it seemed as though the hydrocele would heal, but it came back with a vengeance, causing much pain and discomfort.

On June 18, 2001, I had surgery to repair the hydrocele. Two inexplicable results occurred: One, I had a bruise on the outside of my right thigh that looked like a horse had kicked me. No one associated with the surgery could remember whether I had fallen off the gurney or any other reason for the bruise, which took a month to go away. Two, my penis appeared as though it had literally been turned inside out. No explanation for that either.

True to form, my hydrocele was , of course, different from the usual case in that my doctor told me they had to follow it 6 to 8 inches up inside my abdomen. Ouch!

The day before my final post-op exam I passed some blood in my urine.

My doctor confirmed hematuria and suggested a cystoscopic exam and x-rays of my kidneys. His best guess was a possible bladder tumor. Oh happy day!

June 25, 2001, brought the cystoscopic exam.

The exam eliminated bladder tumor or kidney problem, but pointed to

a prostate origin for the blood. After the procedure, I was required to pee in a cup before being allowed to go home. I could only manage a few drops, but they released me anyway.

Late that evening I realized that I could not pee at all. Only those who have had this problem can relate to the excruciating pain that accompanies this condition. The trip to the emergency room seemed to take hours, and I was begging to be catheterized by anyone in the room. After what seemed like another hour the catheter was inserted by a nurse and I got some relief. I was sent home with a leg bag. I went to see the doctor on July 31 hoping to lose the leg bag and catheter. No such luck. The Doc said keep it in until trans-urethral resection of my prostate scheduled for August 3rd.

The operation was uneventful, at least for me, as I was asleep during the whole procedure. Went home with another leg bag August 5th. Passed some blood, some clots, etc, and was told that was normal. Oh, and of course, no heavy lifting. August 10 brought another trip to the doctor, where I was left alone in a room with his young and very pleasant looking nurse.

She deflated the "ball" and yanked the catheter out creating a feeling I would like to give her someday.

Joy! oh Joy!, free at last, free at last! At this point I had had a catheter inserted in my penis for 17 days. Still passed some dark urine at times and a few clots. Still told this was normal. On August 21 I peed 250 ml at one time! I was ecstatic! Even though I had to wear a depends pad all day as well as night, I was happy to be free of the catheter. I was not having any nocturia, but I was having a lot of trouble holding urine while standing or sitting. Doctor assured me that control would come in time.

Saturday night, August 26, we had company. They went home around 11:30 PM. Afterwards, my wife and I watched a tape of the NASCAR race that had taken place earlier in the evening, going to bed around 1:30 AM. At 2:00 AM I got up to pee. PURE BLOOD! The wife got up asking me if I was ok. I said "No" and went to call the doctor's answering service. Three trips to the toilet in 5 minutes filling the bowl with blood, then it stopped. The bleeding did not stop, the blood just stopped coming out!

Wife blew through two stoplights in the seven miles to the emergency room. I was gasping and puffing and wailing like a woman having a breech birth, as my bladder got bigger and bigger, packed with blood.

Got into the emergency room at 2:20 AM, began pleading for a catheter. Total, absolute, agony. Collapsed into wheelchair. Finally put into a small room on an exam table. The emergency room was full. Saturday night shootings, motorcycle accidents, and me lying there screaming in pain as my poor wife stood holding my hand. About 3:30 nurse gave me a shot of morphine into my IV. I could not tell any difference. More morphine. Still no relief. Around 4:15 AM a male nurse came in and inserted a catheter.

Nothing came out of the catheter. Another male nurse showed up and the two of them left to find a larger catheter. They finally returned and inserted the catheter. Some blood began to come out. They hooked up a saline irrigation bag. Blood began to come out of my penis around the catheter as well as through it. One of the men remarked "I know why that's happening, we put only 10 cc's in the ball and it's a 30 cc Foley!". They put more saline in the Foley ball. Blood flowed out of the catheter for about 5 minutes, then stopped. Totally.

At 4:30 AM a real doctor showed up. He said he wanted a larger Foley, one he referred to as "the garden hose". Having that catheter inserted had to be like having a watermelon shoved up your anus. One he got it in, he took a large syringe full of saline, inserted it into the catheter, and began pumping my bladder, by pushing saline in and then sucking it out. What was coming out was clotted blood the consistency of thick chocolate pudding. During the process he remarked to his nurse assistant that this was the largest blood clot he had ever removed from someone's bladder. He said that when he was only halfway through! Once done, he removed the "garden hose" catheter and replaced it with a smaller one, saying that he did not think it would be a good idea to leave such a large one in for very long.

Almost every time someone says that they peed pure blood, doctors discount the remark, because a little blood in the urine looks like a lot.

Based on my blood count when I entered the hospital, the doctor said that I had lost at least two pints of blood by the time I got to the hospital. I was admitted to the hospital and received two units of blood via transfusion.

My doctor said I was one in 500 that had this many problems with a TURP.

August 28, I was released from the hospital, again wearing a Foley catheter complete with leg bag. Oh, and of course, instructions for no heavy lifting.

September 4, back to doctor. This time old nurse (my age) removed the Foley.

Went home feeling weak, but hopeful.

September 6, 10:30 PM, had to pee only 5 minutes after going. Pure blood.

Splatter all over the bathroom. Did not wait to call the doctor this time. Immediately took off for emergency room. By the time we got there, I was again in excruciating agony, running into the emergency room asking where was the restroom. Made it into the restroom and sprayed blood all over urinal, floor and wall. Almost fainted in restroom where I was alone. Made it out of restroom and into wheelchair. Wife had gone to park car. I recited again the list of medications I take. Back to exam room. Back to the agony of a swelling blood filled bladder. This time waited only 30 or so minutes before catheter. Of course, first catheter was too small. Doctor came in with larger one and pumped me out again.

During this process, even though I was feeling relief from the pressure in my bladder, my blood pressure began to drop. The lowest point I can remember was 70 over 40. My entire body began to tingle and go numb, and I honestly believed I was dying. I remember telling the doctor that "I'm going". I could feel myself slipping away. As there was nothing I could do about it I felt a strange acceptance of the situation and felt more like a spectator than a participant in the action. Quick changes were made to my IV, with several injections directly into the IV and I came back. Fortunately, my wife had left the room to go to the restroom at that time, and I was feeling more alert when she returned. I told her of the experience and she wanted to know if I had seen a bright white light. I replied, “None other than the one shining down on me right now”.

The doctor took out the large Foley and replaced with smaller one. He was training a young female resident while he was treating me and posed her the question, "How many cc's will a 30 cc Foley hold?" She answered "30 cc's?" He said, "No, it will hold about 130 cc's, and I'm going to put 100 cc's in this one to make sure it stays in place.

Admitted to hospital, got to room at 2:00 AM. Transfused with two more units of blood. Doctors said they were reluctant to go back into my prostate, saying that going back in often caused more trouble than it fixed, however, they scheduled tentative surgery for Saturday, Sep. 8, 2001, at 1:30 PM. Emergencies arose (A 78 year old man, also a TURP patient, also had hemorrhage, and his bladder actually burst), and decision was made to put off my surgery until Sunday, Sep. 9, at 1:30 PM.

At 10:00 Sunday, Sep. 9, (my wife having just left, planning to be back before my surgery at 1:30) an operating room nurse came in my room and said we were going to the operating room. Arriving in the operating room, I asked who would be in during the procedure, and told them that my Foley had been inflated to 100 cc's, and that they were not to remove 30 cc's and then jerk it out still holding 70 cc's. They agreed that that was important information to have. Wife almost missed the whole thing, got back just as doctor came looking for her afterwards.

Late Sunday afternoon, doctor came to my room and said "You needed this surgery". He referred to my prostate "oozing blood" and said that they had removed what he described as an "old" blood clot that was about the size of a 12 ounce soda can and was difficult to break up. I asked him what he meant by "old" and he replied that it had likely been in there since right after the original TURP surgery.

September 10, late afternoon: Released from hospital. Wearing Foley and leg bag. Oh, and no heavy lifting! Actually Doctor said do nothing until further notice. Have appointment for Sep 13.

Sep. 13: Doctor recommended leaving catheter in at least until Sep. 17. Gave me proscar tablets to take daily. All the doctors in the medical group discussed my case and came up with the idea of trying to shrink what’s left of my prostate by my taking proscar for a month or so. Began taking Proscar. Friday and Saturday my urine was clear. On Sunday I passed several clots and urine turned the color of cherry Kool-ade. Went back to Doctor on Monday. I told him I was beginning to become discouraged. He said he was too. After consultation with one of his colleagues, he prescribe Amicar, a blood clotting agent, to be taken four times a day for three days, starting that day. After hunting all over the city for Amicar, finally found some and began taking it. By the second pill, urine had cleared nicely. The next day, Tuesday, the night bag was clear. Mid-morning produced a “red” bag, however.

Since the original surgery, I had been drinking about six quarts of clear liquid (no caffeine) every day, which meant that I had to empty my leg bag at least once every hour. By mid afternoon, the bag had cleared. Wednesday morning the night bag was again clear. Got up and strapped on the leg bag, which immediately began to turn red.

Finished Amicar regimen, visited doctor next day. Three doctors said take out catheter, two said leave it in till Monday. Scheduled to have catheter removed Monday, 62 days after first catheter was inserted, and 53 days since the TURP operation. All in all, I have had a catheter inserted in my penis for 46 out of the last 62 days.

In the period following the removal of the catheter the emotion underlying

My every waking moment was terror. Every urge to urinate exacerbated the fear that what I was going to see was pure blood spurting once again from my penis. The first week brought some scary times when I passed small blood clots and pink urine from time to time. Bladder control is a sometimes thing, with the need to wear a depends pad at all times. I have been assured that control will return. I have also been assured that my bladder capacity wil increase from the average of from 160 ml that is is now. I did evacuate 320 ml one time upon waking one morning, but that seems to have been a one time event for now. My goal is to be able to hold a “normal” 480 ml of urine before having to urinate.

November 14. I still have to wear a depend pad, both day and night to prevent accidents. Control still is a problem, but ever so slightly it appears to be improving. Volume still averages below normal, but Doctor says that will improve as control gets better. The aftermath of the hydrocele operation is still with me in the form of extreme tenderness in my right testicle and spermatic cord. I have noticed no change in this for quite a while.

August 26, 2002. Although my bladder capacity is still not as great as I had hoped. I regularly can hold 360 to 380 ML. As I said before, for the last ten years it was second nature for me to constantly be aware of the possibility of need to urinate on a moments notice. I was always planning where I could go next. Every time I would enter a store I would first determine where the restrooms were before doing anything else. I no longer have to locate the restroom with the same urgency as before, and can even enjoy the luxury of drinking a coke or glass of tea while away from home without the fear of a sudden need to urinate. Some things are still problematical, however. If I squat or sit down on the ground, I sometimes experience involuntary leakage of small amounts of urine. Achieving and maintaining an erection is also difficult, even with Viagra.

All in all, I wish I had had the operation years earlier as far as the frequency of urination issue, but would rather have forgone the experience of the complications, especially the last mentioned one above.