The Patient Was…

The patient was in his mid-sixties, with mildly elevated blood pressure and a markedly enlarged prostate gland.

Since the combined occurrence of prostate gland enlargement, and coronary heart disease characterized by obstructed blood vessels supplying oxygen to the heart muscle, is seen predominantly in older men it is common for cardiologists to see patients with both conditions. While the ultimate decisions regarding treatment of prostate trouble are usually made by urologists, physicians specializing in diseases of the urinary tract, cardiologists are often involved in helping to assess the risks of treatment in patients with both cardiovascular and prostate disease.

The patient’s only cardiovascular problem was easily controlled blood pressure, which could have been successfully managed by his primary care physician. But he said he enjoyed visits to the office and felt safer under the care of a cardiologist.

A frequent topic of discussion in the office was the patient’s prostate condition. He regularly saw a urologist who repeatedly urged him to have prostate surgery to relieve the obstruction to the flow of urine that frequently landed the patient in the emergency room. Each time he wound up in the ER, he underwent urinary bladder catheterization in which a soft, flexible tube was carefully threaded through his penis and up the urethral tube into his bladder.

Although the dangers of repeated catheterization, such as infection and trauma to the thin-walled urethra, were explained to him over and over, he had a nonchalant attitude toward the procedure. It had always gone smoothly and painlessly, and he considered it a satisfactory way of dealing with repeated bouts of urinary obstruction. He would not change his mind.

On one visit to my office, he asked me to do a more complete examination than I usually performed during his routine appointments. He wanted, he said, a “complete checkup.” When I asked why the request for a full workup, he informed me that he was planning an extended business trip abroad. Further questioning revealed that he planned to visit potential remote manufacturing sites for his business, including locations in rural Korea, Cambodia, and other Asian nations.

I told him that his general health was certainly good enough to withstand the rigors of such a trip. But his prostate trouble was a real red flag. I explained that it was quite likely that he would experience an episode of urinary obstruction while he was away.

He said not to worry. Men all over the world must have prostate problems, he figured, and they must get urinary catheterizations, too. So, despite my urging, he was unwilling to change his mind about having his prostate fixed before the trip abroad.

He did agree to one thing, just to appease me: to see a urologist of my choice before he traveled. I wanted to get it done before he changed his mind about that, so I called a close colleague of mine whose urology practice was around the corner from my office. I explained the problem: a man in his sixties, healthy enough to travel to remote locations in Asia, but with a serious prostate condition that he refused to have fixed.

My colleague said to send him right over to his office, and he felt sure he could convince the patient to have surgery. I said that I knew this patient well, and he wouldn’t take my earnest advice. How was my colleague, who had never seen the man before, going to convince him otherwise?

The patient went around the corner to the urologist’s office. I was sure that northing would come of it, but I wanted to touch all the bases I could before he ventured into areas that were relatively medically under-served.

A short time later, my urology colleague called me and said the patient was being admitted that afternoon, and prepped for surgery. I was astounded.

“What did you do, what did you say?” I asked the urologist, almost in disbelief.

“Simple,” he said. “The patient said he was sure that he could be catheterized anywhere he traveled.“

“So, what did you say?”

“I told him that he was correct. Then, when he sat back looking smug and sure of himself, I simply added that the penile urethral catheters they insert in Asia are made of bamboo.“

“No!”

“Surgery in the morning,” he said.