NOT EVERY UROLOGICAL PROBLEMS REQUIRES A SURGERY!
A man in his fifties was waiting for me in the clinic. My clinic starts at 11 am but he was eager to see me that he had arrived at 10:30 only. He was tired of his urinary symptoms which were on going for around 3 years. He was having treatment but no avail. Sadly, neither his problems were identified correctly nor treated correctly. He heard about me and immediately came to seem me with a hope that I would treat him and relieve him from his problems.
Sometimes people have certain concepts or ideas about their preferred choices of treatment, and he wasn’t the exception to it. Since he had no avail with treatment, he had made up his mind for a surgical treatment, or probably he was told that the surgical option is the only option available for him. He didn’t know what surgery he may need but had decided that he would need some kind of surgery. This is the time when an experienced surgeon’s intervention is required. Surgeon with experience and knowledgeable knows exactly when and what not to operate, and how to make his patient realise the facts. Some surgeries could make things worst for patients and those changes becomes irreversible, leaving the patients with lifelong suffering. In my practice I have always kept the surgical option as the last resort unless the surgical option is only option available.
I always make a point that my first consultation is thorough one and I spend sufficient time with patient. During my first consultation not only, I get to know the patient’s symptoms well but also the patient well. Including understanding the areas where patients are struggling to explain their issues. I make a point that I spend sufficient time with patient and their relatives (if they prefer to have friend or a relative with them), understand exact problem, discuss treatment options to their satisfaction and to answer all their queries to their satisfaction. Hence, I adjust all my new patients’ appointments in such a way that I spend good enough time with them. This gentleman was no exception to that.
After thorough history, examination and establishing his exact issues I came to conclusion that even though he was in age group for prostate related problems, and even though his prostate was enlarged he had no symptoms suggestive of prostate problems. His issues were mainly related to his bladder. Off course there are surgical options to treat the bladder related issues, but it is not my practice to directly jump to surgical option without trying medical treatment for certain conditions. Some exceptions such as cancers would be there where surgical option would be preferred straightway.
Since he had no prior treatment for his bladder related symptoms, I explained him in detail the role of the medical treatment along with risk Vs benefits. At the same time, I also explained him the risk Vs benefits of the surgical option. Through a thorough discussion I helped him understanding the problem, the treatment options and the best option at present time for him. I also explained him that unless absolutely necessary we should keep surgery as the last option if we are able to manage the problems medically. It would certainly reduce down his cost of treatment also to a significant amount.
As previously explained in my previous posts, in such cases I always prefer and offer to do cystoscopy (internal examination of bladder) in certain age groups to rule out sinister and other causes. We carried out cystoscopy for him. Luckily his bladder was normal, his prostate was not blocking from inside. At this stage I also stretched his bladder a bit (had consented him already), which is one of the temporary options in treatment of irritable bladders. This neither involves any major procedure on bladder nor trauma to bladder but can prove as simple beneficial procedure.
He did very well after the procedure and is currently doing extremely well with bladder stretching along with the medications he is on. There are couple of groups of medicines for the same condition, but it is very imperative to choose correct option for the patient as per the age of patient, occupation, previous treatments, associated comorbidities, side effects and dietary habits. When I started treatment for the gentleman, I considered all these aspects, his wish, his understanding and his compliance with the treatment.
During this unprecedented situation of coronavirus pandemic and the lockdown my routine OPD is off but I am making sure that I speak to all my patients regularly. I do telephone follow up, answer all their queries, and also boost their moral in this unprecedented time on keeping and staying well with family at home. Off course after the lockdown this gentleman would be seeing me in the clinic for regular follow up, but he is very happy and satisfied with the treatment. He is very happy that through my correct advice and discussion he could make an informed decision of the type of treatment he would like to try initially. He is also happy and satisfied with the fact that for whatever reason if the medical treatment stops working or his irritable bladder becomes refractory to medical treatment, I have an effective and evidence based surgical option available for him. But we will cross those bridges when we come to that………