Posted 8/16/2010 2:34 PM (GMT -6)
You can read about my latest cath change in the other post. The main reason we went to uro today was to discuss what to do long term. And I wanted my wife there so she could hear first hand. I had a list of 25 questions about the urinary diversion surgery, and we went over each and every one, slowly. This visit lasted just shy of an hour, and my dr. was in no hour, despite having a full lobby.
He told us that my bladder was in very bad shape from the radiation, and that he fully believed that it would never get better or heal on its own, not as long as urine kept entering it. He also said that despite 6 operations to keep the bladder neck open from strictures, that it was never going to cease being a problem. There' more evidence then ever, that my SRT should have never been done the way that it was, and that most of the damage will be lingering and perm.
Looking at doing a Ileal Conduit Urinary Diversion Surgery sometime in mid-to-late September. It is a major but common urological surgery, often done for people with bladder cancer. He has done lots of them in his career, and its considered the "gold standard" of those types of surgery. He expects 2 to 2 1/2 hours of surgery, and 4-7 days in the hospital, and about 6 weeks of at home recouperation time.
My hospitial, St. Francis, has an excellent stoma/ostomy nursing staff to teach us how to live this new way of urinating. And its the same hospital that has the best patient care in the state of SC year after year. This will be my 8th surgery since 11/2008.
He said in theory, it could be re-versiable, but why? He doesn't want to remove my bladder, because it would add a lot more complications and surgery and healing time. He said its possible one day, they may have too if there is ever any evidence of bladder cancer.
The prep for this surgery is very involved, and I will be spending time with a stoma nurse experimenting with the future placement of a stoma.
They usually use a piece of the lower bowel in this op, but he said if it looks too radiation damaged when he's in me, they will have to use some material from the colon higher up, which will add to the surgery time. He said there is no way to know until he's in there.
This is good and scary at the same time. I need quality of life here, and I think I have done all I can in tryin to tough it out all this months hoping for a natural healing situation. But that's not meant to be.
While this started out as a chronic stricture problem from the initial surgery, it has become a mega disaster from the SRT. I am still mad at me for going against my own gut feeling. For me, the worse case scernio from RT happened.
As far as my rising PSA, he's deeply concerned, but said what I have said, let's wait till the next reading in November, if it goes up at all again, then probably would mean the SRT failed. Worry about one thing at the time was the attitude.
He said he definitely would not do HT at this time, that its important not to mask the natural direction of the PSA at this point. He said it may come down to HT ultimately, if I plan on living longer, but we need to watch the psa right now.
My PC journey is about to take a new twist, and enter a new phase. I don't look forward to another major surgery, but then, I can't keep going in this world of pain and hurt all the time.
David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39