another TURP after radiation?

[spencoid2]

I just saw the Urologist who performed an emergency TURP on me (prostate irradiated both with IMRT and Brachytherapy)after I was assaulted by a doctor cramming a catheter through my urethra. He is young but very smart. His specialty is robotic surgery. He is confident and I feel that his opinions although not based on a million years of experience are worth considering.

It took me nearly two years to heal from the first TURP but this was after serious damage from the catheter. It seems that I have finally healed but my urethra is so constricted by scar tissue or possibly by recurrence of cancer that the Urologist could not even get a 16 French cystoscope in at all. He suggested that he might be able to use a wire guide but that he did not think there was any point in possibly causing more damage. When I got back home I was able to insert an olive tip coude catheter (the only one I have ever been able to insert).

The Urologist is concerned because I live about 4 hours from a competent hospital where a Urlogist is on call. He suggested that I self cath at least three times a week just to be confident that I will be able to do so if needed in an emergency. He wants to perform the TURP because he is concerned that the contracture could completely close up at any time and is likely to do so.

I will be on Medicare in a little over a month and would like to put it off until them as my current out of pocket max is $6000 a year and just $1500 when on medicare and supplemental. Probably can not schedule surgery any sooner anyway.

Urologist thought (no guarantee) that the healing from a TURP under non emergency conditions will most likely be faster.

Further complication is that I will be traveling in Europe in the fall and do not want to deal with urinary issues when there.

Still do not know if my high PSA is caused by UTI and or trauma. Can not get another test for a couple of months. Hopefully UTI is cured finally. If I am self cathing three time a week I might never be able to get a representative PSA.

So, what are the opinions on doing the TURP or just monitoring with self cathing and hopefully catching a worsening and potential disaster? I have a bladder scanner that seems to be reasonably well calibrated so I can head for a good emergency room if I can't self cath and if I have over a certain amount of urine in my bladder.

On the positive side, it seems I have a very buff bladder from all the exercise trying to get urine to flow. This was shown on the CT (uroscan) scan I got yesterday which is normal except for a very tough looking bladder.

I really do not want another TURP after tha last one taking nearly two years to heal but also do not want to have an emergency that can not be dealt with easily in my remote location.

[PatrickGA]

So sorry to hear about your situation. You say you were "assaulted by a doctor cramming a catheter through my urethra" - that's a really big deal. Is that not malpractice? Is there any grounds for legal action. I sure would investigate that with a knowledgeable attorney.

But the main thing I wanted to comment on is Medicare. I don't think you have accurate information about its deductible. When I was first diagnosed with prostate cancer (about 5 years ago), I was in a similar situation with private insurance. Also with at least a $6000 deductible and maybe $600-700 a month in premiums. I had just gotten on Medicare when it was time for a second biopsy, and few months later started the process of MRIs and scans and eventually surgery to have the prostate removed. My total medical bills for that first year on Medicare were at least $100,000 - and my total out-of-pocket expenses were about $175, which is what Medicare's deductible was that year. No co-pays, no nothing. The next year I had to undergo both radiation and hormone therapy (ADT - Lupron). Radiation alone was over $100,000 and I know the ADT process wasn't cheap. But again, no co-pays and maybe $175-180 for the Medicare deductible. So after 3+ years on Medicare, and lots of medical procedures and a shitload of costs, my total out of pocket has been less than $1000, not including monthly premiums which have been manageable.

The important thing is to ask questions and make sure all your doctors and hospitals and clinics DO accept "Medicare assignments" and DO NOT engage in "balance billing" - which means sending you a bill for the difference between what they charge and what Medicare reimburses them (which is always less than what they charge). I think the deductible this year may have gone up to $185 - it creeps up, along with the premium. But the premium is only about $135 (I forget exactly. It's not much and comes out of my social security payment.) I'm on traditional Medicare and have a supplemental policy that costs an additional $150 per month. If you go with Medicare Advantage, you probably won't have any premium for the supplemental, and there are other benefits. I plan to change to Medicare Advantage later this year. It's really important to do your research and make sure that all your providers accept Medicare assignments. And not all medical people accept Medicare Advantage so it's important to ask about that if you decide to go with a Medicare Advantage program. I strongly suggest you talk with an insurance broker for complete details on insurance (no cost to you to use a broker) - or look into all the various advice that is available from AARP.

Good luck with everything. Tough getting old, but its manageable with some good advice.

[spencoid2 in reply to PatrickGA]

I live in California and the insurance companies made medical malpractice virtually impossible because lawyers can not make money on it unless you are at least dead. The California medical board is investigating and will most likely find against the arrogant bitch.

Just applied for medicare today and also SS. it looks like the SS will cover medicare cost as well as supplemental with a few pennies left over. We were surprised that i would get a decent benefit as spouse. We had Blue Cross through UC and it was about the best insurance rich people could get so was good for us as well. Supplemental through them will be about $150 a month and cover hearing aids and a bunch of other stuff as well as coverage in other countries. I guess I married the right guy although he did pretty well too