My GP (General Practitioner) set me up with a urology specialist, who I met with today. The good doctor was very nice and pleasant. He explained that based on my good health and relatively young age (bless him, I’m 57) and with only blood showing in the urine, he expected this to be a small, very early problem that should be easy to fix.
Most of the time, he said, this kind of problem was not caught this early. Additionally, he was curious to know how I had detected the problem so soon. Once I explained that I worked in a medical laboratory, within the same medical complex his office was associated with, he understood. Doc was not surprised to learn that I was a health related employee. He understood automatically that this meant I was paying attention to what my body was telling me: That I, on occasion, paid attention to what I could notice—like the appearance of my urine and my stool. (Yes, it is important to notice these things, though they may be disgusting.) He also gently reprimanded me for performing my own urinalysis testing. It’s considered poor laboratory practice to run your own samples. I knew this, but what the heck, at this point, discretion was more important to me. He sent another of my urine samples to the Cytology department, which would check for free-floating tumor cells. (This developed another good sign, as none were found.)
Anyway, he set me up with a few exams: ultra-sounds for my bladder and both kidneys, a CT exam including a contrasting die injection, and a cystoscopy exam.
I’m sure you have a good idea what an ultra-sound is. This is where the technician has you lay down on an exam table, you lift your shirt and she applies some warm, water-based oil to your skin. Then she places a handheld device into the oil, pressing it against you. The device sends ultra-sonic sound waves into your body, which produces a grainy picture on the computer screen. She asks you to turn on one side so that she can position the device above one kidney. She moves it around on your skin as the computer captures images. Then she asks you to turn on to your other side and she takes images from above your other kidney. The entire procedure is painless. She even lets you look at the images, explaining that this fuzzy-grainy picture is the kidney. By law, she cannot tell you anything about what she sees in the image, you’ll have to get that information from the doctor.
The CT (Computed Tomography) examination was new to me. Asked not to eat anything before the test, I skipped breakfast. At the radiology clinic, I lay on my back on a motorized table. The nurse started an IV in the back of my hand and loaded a power-assisted injector, which injects the iodine contrast material on computer command. Once the radiologist started the routine, the table moved me back and forth through the round opening of the CT unit. Inside rotated an X-Ray machine that took x-rays of my bladder and kidneys in a circular format. The instrument told me to inhale, hold my breath, and exhale before and after each scan series. When it injected the contrast material, a warm feeling washed over me (I’d been told to expect this) from my chest to my lower legs, and the instrument took more pictures of me. That was all. Start to finish, only one hour had passed. I left to get lunch.
However, after a routine physical exam by a female PA (Physician’s Assistant), which included a digital rectal exam, the cystoscopy exam was an adventure. I’d never experienced this before. Still, it was interesting. This involved passing a lubricated cystoscope (a solid looking lamp-and-camera-tipped rod that was about a quarter-inch in diameter and twelve-to-fourteen inches long [I might be exaggerating these dimensions] connected to a hand-controller), up my urethra (urine transport tube inside the penis), to directly visualize the bladder interior. Fortunately, the nurse numbed my urethra with an anesthetic beforehand. Doc turned on the color television connected to the on-tip-camera and told me to expect some pressure. This was the instrument passing through my prostate gland. By the time I turned my eyes toward the TV screen, the moving view reminded me of a Star Trek episode where the Enterprise is passing through a wormhole—except this was in real living color! There were shades of reds, pinks and clean whites that made up the urethra. Doc said water was passing into the urethra, which allowed for the pretty pictures being visible via the camera. More pressure ensued as the probe passed the urethral sphincter and the view opened up inside the bladder. Doc moved the camera around and pointed out the two ureter openings (one from each kidney, descending from higher up my torso), the back wall of the bladder, and—tada!—the small tumor he suspected nestled neatly between them.
Doc said the tumor was about 2-3 centimeters in diameter—small and tiny—about the size of my little finger-tip. He described it as a double-tufted mulberry bush. Pale in color compared to the richness of the bladder wall, the “bush” material looked filamentous, washed-out, and unhealthy. Doc pointed out a bit of necrotic tissue at its base, the suspected bleeding source.
Therefore, with the visual tour over, Doc slid out the cystoscope. Thank the Lord for anesthetic! Doc said he knew what needed doing.
The tumor would be taken care of first, since it was more deadly. Doc also had one more surprise for me: a small kidney stone was located up in the left kidney. He said we’d deal with that later with concussion technology.
Doc left the exam room for a moment, allowing me time to get dressed. When he returned, he handed me a sheet of paper delineating what was to happen next: Cystourethroscopy, blood work (CBC and BMP), with TURBT scheduled for six days ahead.
Final results: Surgery