I first went into retention back in 1999, and have been on the
verge of it ever since, with a pathetic flow rate, getting rid of
80 to 120 ml a go. If  bladder content got above 500ml then
I had to catheterise.

Of course I was offered TURP, but it seemed such a crude solution .
Being in the UK meant a long wait for PVP,and I was finally all set to
approach Mr Muir in London when William posted his account of PVP with
Mr Tim Larner in Sussex. Thanks for that! I rang 01273 627057 for an
appointment and had PVP 3 weeks later. There are good financial
reasons for picking Sussex, though it still cost me 5 month's company
pension. Money well spent though.

There's now a laser set-up at the Nuffield Hospital in Haywards Heath,
where I went on Oct 3rd for PVP in the afternoon. "Digital" exam of
the prostate suggested 60-80 grams. Only the rear lobe can be reached
that way, but the estimate assumes it's a normal shape. Operation time
was expected to be an hour.

I opted for local anaesthetic [spinal block] so I could see the famous
laser in action, and luckily I had a good view of the monitor screen
Mr Larner was using, despite the orange safety goggles we all wore in
case any green laser light got out.

First thing we saw was the prostate side lobes crushing the urethra.
No wonder peeing was difficult. But the median lobe straight ahead was
very small.... not what I'd expected. Mr Larner initially burned a
channel between the side lobes, just so the flushing liquid could
circulate.

That raises an interesting point: Laserscope talk about an average
operative time of under 20 minutes. The vaporisation rate is said to
be about a gram a minute. How much prostate do you remove in under 20
mins? No more than the working channel Mr Larner produced before
getting on with the real job of clearing what he called a 40-year
cavity.

It's harder to steer the laser fibre into the side lobes than the
median. Being ambidextrous helps. I could see on the screen the outer
structure of the prostate that Mr Larner was exposing, but as time
went on more and more inner material was being found and burned away.
But I was still enjoying seeing it go! The energy counter on the laser
reached its record of 260 kiloJoules, then 300. The team  were running
out of CDs to play when Mr Larner was satisfied at 348528 Joules.

The 80 watt laser is fired in short bursts, and I figure it was
powered up for 72 mins in the two-and-a-half hour op. Turns out the
prostate was so large that if I'd opted for that TURP I'd have woken
to find an open prostatectomy done instead.

A size 21 catheter was removed next morning, and after I'd drunk
enough I voided 200mls at an amazing rate, so was allowed to catch a
train home. It felt like I was peeing bits of glass for a couple of
days, but I'd expect that just from that large catheter. I used to use
size 12 as 16s were painful afterwards!

Now I can void 400mls painlessly, as long as I ignore the feelings of
urgency as the bladder fills. If I give in and pee too soon, with
maybe 100mls, then the pain at the tip of the penis can be unpleasant.
The bladder has thickened with the extra muscle needed to force urine
through the flattened urethra, and this restricts its blood supply
when it is contracted. So presumably it is happier trying to expell
urine if it starts out expanded. Hope I've understood that right.
Anyway, things may improve as the un-needed muscle disappears.

No retro, by the way. I'm surprised, considering how much was removed.
Still, Tim Larner is clearly a perfectionist.... he's familiar with
the other methods and is very keen on PVP, which he trained on in
Detroit.  Also he tries to keep costs down for self-funding patients.
Well, not many UK consultants drive a Fiat!