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Medical Forum / Diseases and Disorders / Prostate BPH / August 2003PVP at Princess Royal Hospital
There are two hospitals in the U.K. which offer the Laserscope PVP treatment, one of them is Princess Royal Hospital in Sussex. There are 2 urologists carrying out PVP at Princess Royal and I made an appointment with Mr Tim Larner. At the consultation Mr Larner established the following bio: Age 60; BPH 5 years; Flomax 2 years; Flow rate Qmax 7.7 mls/sec, Qaverage 2.8 mls/sec; voided volume 211 mls, residual volume 116 mls; IPSS score 26, QOL score 5. Rectal examination showed large prostate of about 80 gms. My PVP operation was carried out at Princess Royal on 16 August, I was the last of 3 patients operated on that morning. Mr Larner advised that because my prostate was greater than 70 gms I would be kept at the hospital overnight. The nurses took me into the operating theatre at noon and I woke up at 2pm in the afternoon. I felt clear headed and in no pain. A catheter had been fitted and also a saline drip. The catheter bag filled up and was a dark red wine colour. The nurse advised that the bleeding would have to be less before they would release me. I drank a carafe of water and in the morning the colour had changed to a light rose and the nurse removed the catheter. Mr Larner visited and advised that the operation had gone well and that he had removed a lot from the prostate, he thought that I would notice a big improvement. I left the hospital at 11 am and my wife drove me home. I am slightly amazed at how easy it has all been, anyone who met me on Sunday afternoon would have had no idea that I'd had just come back from surgery. These are early days but here are my initial impressions. Flow rate has improved markedly and from memory is back to where it was before BPH. The urgency has increased, when I go now I have to go - no waiting. Surprisingly to me the frequency is about the same as when I had BPH. As an experiment I drank a pint of water quickly and then had to go to the toilet 3 times at 20 minute intervals to void what I guess was about 1/3 of a pint each time. So I am going to the toilet as much as before but spending a lot less time there. Overnight is a big improvement and I'm getting up 1/2 times compared with 3/4 times before. I am a little puzzled about the frequency, was the bladder damaged over the years of BPH or does the bladder take some time to 'learn about' the new situation? Overall I'm very pleased with the results, taking it easy this week but plan to start normal activities next week. William Glad to hear that you are feeling so well just a couple of days after a PVP. Pre op I had just about the same numbers you quoted, just reverse your voided and residual numbers. I had a large medial lobe that was well up in the neck of the bladder. The only numbers that are somewhat odd to me are your day time frequency numbers after the PVP. Hopefully they will improve considerably within the next week. I would say most of us were able to void 150 to 200 mL at a time a few days after the op and be going only every 1.5 to 2 hrs. Your night time numbers are typical and may improve to only once/night within a couple of weeks. Your "bleeding" (it really only takes a few drops to color the urine pink) should completely stop within a week of the operation, although a few have had some bleeding for up to three weeks. Glad you had it done, as I know you are now that it is over. Good luck with your continued recovery. It takes at least 3 months before you have your final Qmax, Qavg and retention numbers. Jack > There are two hospitals in the U.K. which offer the Laserscope PVP > treatment, one of them is Princess Royal Hospital in Sussex. There [quoted text clipped - 35 lines] > Overall I'm very pleased with the results, taking it easy this week > but plan to start normal activities next week. Thank you for your report. Was your op done privately or via the NHS? Also, could you let us know what was the delay between first contact and the op? All the best for your recovery Tom > There are two hospitals in the U.K. which offer the Laserscope PVP > treatment, one of them is Princess Royal Hospital in Sussex. There [quoted text clipped - 35 lines] > Overall I'm very pleased with the results, taking it easy this week > but plan to start normal activities next week. Tom, My op was done privately. Initially I tried to go through the NHS and asked for a referral from my GP. He advised that he could only refer me to the one of the 6 hospitals which surround his practice but none of these hospitals offer PVP. The GP said that he could give me a referral to a local urologist who could then give me a referral to a hospital outside the area which does PVP. However the GP was pessimistic that any local urologist would give such a referral for PVP because the procedure is so new to the U.K. I decided to cut past the bureaucracy and arranged a private consultation with Mr Larner, who is performing PVP at Princess Royal in Sussex which is about 1.5 hours drive from my home. The costs, for anyone thinking of going the same route, are: Initial Consultation £125. (This was very thorough, it included a flow test and an ultrasound of the bladder and lasted 45 minutes.) PSA blood test £50 Hospital charge £2138 (This included the Laserscope fibre which I understand costs about £750.) Surgeon's fee £619 Anaesthetist's fee £275 Total £3207 (This is about $5,100 at an exchange rate of £1=$1.6). I am not covered by private insurance and paid this from my own resources. I think now that it was money well spent, the BPH was becoming a misery and now that it is over I feel that a weight has been lifted off my shoulders. For example I slept like a log last night and only got up once at 4 am, with BPH I was getting up 3 or 4 times and this affected the quality of my sleep. If you go privately then things move fast and I would guess that currently you can probably be operated on within one month of the initial consultation. > Thank you for your report. Was your op done privately or via the NHS? Also, > could you let us know what was the delay between first contact and the op? [quoted text clipped - 42 lines] > > Overall I'm very pleased with the results, taking it easy this week > > but plan to start normal activities next week. William, You got a bargain. Here in the US, my PVP cost $16000. Fortunately for me, it was paid mainly by Medicare insurance and supplemental insurance. Of course, I had to pay for years into these insurances, so, it is really not as "free" as it sounds. Then I had to travel thousand miles to Santa Barbara and spend four nights at a hotel at my expense. I fully agree with you, all expenses is money well spent in this instance. With Medicare, we can choose a doctor, anywhere in the country. It is incredible to me, that there is a serious movement to change this system and go to a NHS or Canadian style system where services are "completely free". Good luck with your recovery. Fred Henzi I hope you are doing good progress > Tom, > My op was done privately. Initially I tried to go through the NHS and [quoted text clipped - 28 lines] > currently you can probably be operated on within one month of the > initial consultation. $16K sounds awfully high for an out-patient procedure to me. My mother-in-law was in the hospital for 4 days and had surgery for a broken hip and that's what her bill was. > William, > [quoted text clipped - 45 lines] > > currently you can probably be operated on within one month of the > > initial consultation. William Thanks for all the info. Since my last post 3 days ago, my current uro has agreed to refer (through the NHS) my case to the site of my choice, ie King's College or Princess Royal! It's only taken me 3 uros and 9 months to get to this stage, but I'm here at last. I've been in touch with King's and the Princess Royal and both sites are prepared to take new cases, so now I have to make up my mind where to go. What a wonderful situation to find oneself in! King's has a slightly longer track record - October of last year - but it is a teaching situation and I might have a trainee surgeon perform the op, albeit under Mr Muir's supervision. As far as I know, the Princess Royal started PVP in February of this year and just have the 2 surgeons who must have built up quite some experience in that time. Will keep you posted on my progress and thanks to everyone on this group for the help. Tom > Tom, > My op was done privately. Initially I tried to go through the NHS and [quoted text clipped - 75 lines] > > > Overall I'm very pleased with the results, taking it easy this week > > > but plan to start normal activities next week. > It's only taken me 3 uros and 9 months to get to this stage, but I'm > here at last. Ah, so only 12 months to go then! Neither the law nor the NHS can be hastened. One way to reduce the waiting lists is to hope we all die off from old age before they have to operate. Derry William, From other posts, I conclude that recovery is quite individual. I had also sudden urgency and two hour frequency after PVP. Both improved with time and after 3 month I can hold for 5 hours and there is no urgency nor burning after urination. I noticed that my frequency was partly psychological. Pre PVP, fear of acute closure drove me to void at the slightest sensation in the bladder. It took me about two month to get over this habit. And even now, when I step up to a crowded urinal, I have some phobia that I won't be able to cut loose. It works every time though. Relax, think positive and let time heal. PVP may be a rather quick surgery, but in my humble opinion it is still full blown surgery. Maybe you need some painkiller for a while. Good luck Fred Henzi Jack and Frederic, Thanks for your comments, it is reassuring to get advice from experienced men who have been down the PVP trail before you. Mr. Larner has notified me of a follow up appointment on 18 November where he will measure again the readings recorded at the initial consultation. I will relax and go with the flow, so to speak, until then. Derry, I would not plan to drive the next day. If your experience is the same as mine you will not sleep well in the hospital because of catheter, strange surroundings and the monitoring activities of the nurses. Also you will have had a general anasthetic which knocked you out cold for 2 to 3 hours the day before. I nodded off on the drive home and I don't think that I would have been alert enough to deal safely with the heavy London traffic. Allow 7 to 10 days to fully recover. Frederic's comment is right, PVP is full blown surgery albeit of short duration. Tom, Princess Royal have been carrying out PVP since March 2003. There are 2 urologists doing the PVP operation Mr Nawrocki and Mr Larner. Mr Larner has now completed about 30 PVP operations, he does 3 PVP's in one session and I think that currently he operates 3 times a week. Princess Royal is doing a prospective trial on PVP for the NHS. While I was there the hospital placed an order for a further 100 Laserscope fibres. Discussed PVP with the nurses who told me that both consultants are keen on the PVP procedure. PVP patients stay 1 night in hospital compared with 3 to 4 nights for TURP patients. Also PVP patients require less nursing care than the TURP patients. The catheter for PVP is single tube whereas the TURP catheter is triple tube to allow for irrigation. One of the nurses described TURP as "the old fashioned procedure" which just about says it all. Good luck, either Kings College or Princess Royal will do a good job for you. > William, > From other posts, I conclude that recovery is quite individual. I had also [quoted text clipped - 13 lines] > > Fred Henzi > Derry, > I would not plan to drive the next day. Thanks, William. My brother lives just ten minutes walk from King's and I have a neice a step or two further away. The admissions nurse has told me that I will only be released into the care of a responsible adult! (Not sure if my brother qualifies!<VBG>). So I am planning to stay the night with one of these then possibly visit my sister for a couple of days in Reading (an hour by rail?). I'll then travel home (500 miles) by rail or air. My concern is about how much I can do when I get home. I am a bachelor farmer and have livestock to attend to. I can arrange to get away for a few days but anything more than that is a problem. At least October is a quiet month! Your advice is much appreciated. Derry |
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