Through the Keyhole

All the results are now in from the procedure that was carried out at the beginning of last week. The cytology report of tests carried out on samples taken from the inside of the left kidney speak of abundant malignant neoplasia cells, with the one-word conclusion, "Carcinoma" (cancer).

Yesterday and today I spoke to the doctors invloved and the decision has been taken to remove the left kidney and ureter. This will be done through means of what is politely referred to as keyhole surgery, though the keyholes are still quite large, as can be seen in this video (not for the squeamish) of a similar operation, though on the right side.

If you like long words, the operation is called a nephroureterectomy, a word which would probably win any Scrabble match.

The date of the operation must still be fixed, depending on approval from the insurance company.

Good news, bad news

We had to be up early on Monday morning in order to be in time for my appointment at the hospital at 07:15. Yes, that's a quarter past seven in the morning!

We arrived on the dot and were surprised to find that the admitting staff were there, too (last time we had to wait about twenty minutes for them to arrive), and that all was ready and waiting, so that withing about ten minutes we were on or way up to the room.

Shortly after entering the room the nurses were there with their razors, ready to shave me in all sorts of places: I was still in my ordinary clothes! So, out of the street clothes, into the operating gown, lie on the bed, scrape, scrape, scrape, ready to go down to the theatre area, here comes the orderly and off we are. Things have never moved so fast in Spain, I can assure you.

And it didn't stop there, for I had hardly arrived at the waiting area, when a nurse was already trying to find a vein in my hand (always difficult) and the anesthetist was asking questions. I don't know much of what happened after that, as I was given sedation: I vaguely remember being lifted up in order to have the epidural injection in my back, but that's about it. Next I know, I was in the recovery area and shortly after that I was back in my room with full plumbing (both the room and myself).

The procedure that had been carried out was a ureterorenosopy: looking up the ureter and into the kidney. The kidney couldn't be reached about a month ago, so a ureteric stent had been in place since then. This time, presumably thanks to the stent, the kidney could be reached and examined.

What was found is both good and bad news.

Good because nothing was found.

Bad because nothing was found.

The doctors had expected to find the tumour in the kidney. Had they done so, there was a chance it could have been removed there and then. Even if it were too large to remove immediately, knowing its location would have meant that an operation to remove it could have been planned. Now, hoever, things are rather more problematic. As I understand it at the moment, either the tumour is a flat one, which is more difficult to locate, or the tumour is elsewhere.

In any case, the doctors involved are having a meeting about the case this week and I shall know more about the possible courses of action next week.

I feel a lot better after this procedure than after the previous one. The stent has been removed, so I am much more comfortable. There is already no more blood in the urine (last time it took a full week for visible traces of blood to disappear) and I have far less pain when going to the toilet.

So it's not all bad news after all.

A failure

As reported previously, I had to go to the hospital on Tuesday for a procedure known as a uretroscopy. It was hoped to be able to pass through the left ureter into the left kidney and thereby perhaps find the tumour that is producing the malignant cells.

Things, however, did not go as planned.

The camera was able to enter the ureter easily enough and could be moved about half way along that tube. But then the ureter was for some reason constricted and the camera could not be moved any further, so that the kidney could not be reached. Several attempts were made, but all with no success. It was therefore decided to place a stent in the ureter. Hopefully, this will expand sufficiently to allow the camera to pass freely to the kidney at a later stage.

As a result, I shall have to return to the hospital in two to three weeks time in order to undergo the uretroscopy procedure again.

On a more positive note, the right ureter seems to be perfectly clear. Samples were again taken from that area to check for the presence of malignant cells, but that is more precautionary than anything else. Also the opening to the left ureter and the first half of that tube are clear of tumours.

In case you are wondering, the uretroscopy procedure was carried out under epidural anaesthetic. The procedure itself was therefore quite painless, though afterwards, once the anaesthetic wears off, there is a level of discomfort, as a catheter remains in place all during the night. After removal of the catheter, the pain when urinating is quite significant, though can be controlled to a certain extent with pain-killers. I also feel some discomfort in my left side, though if this is a result of the work carried out during the procedure, or because of the presence of the stent, I do not know.

Quick update

Just back from the hospital and a chat with the urologist.

The uretroscopy will take place next Tuesday evening. What exactly will happen will depend on what he sees during his visual exploration of the ureter and the kidney calyxes.

Whatever there is, as far as a tumour is concerned, it must be extremely small and in a very early stage: although malignant cells have been found in the urine on two different occasions, nothing can be seen in any of the imaging results. If nothing can be found this time, with the visual exploration, then we shall have to wait a few months, allowing the tumour to develop somewhat, and then start the process again. Perhaps then the tumour will show up on images and so can be more easily located.

Anyway, that's all speculation at the moment, and we have to see what happens on Tuesday. Should be interesting, in any case, and I have already received instructions to try to stay awake during the whole procedure, in order to be able to follow it on the sceen kindly provided for that purpose. Must remember to take a camera, too…

Back to hospital

Went to see the urologist yesterday.

He had met with others involved in my case on Monday, so now it was time to learn what they had decided the next step should be.

I shall soon be back in hospital for another exploratory operation. This time it will be for a uretroscopy, so that's another scopy to add to the collection.

The cancer cells seem to be found mostly in the urine that is at the mouth of the ureter that comes from the left kidney. As a result, those in the know want to look up that ureter and into the renal calyxes to see if a tumour can be located somewhere there.

If a tumour is found, what happens next will then depend on the size of the tumour, its exact location, etc.

Scan after scan

In the previous entry, I wrote that I was to have an MRI scan and a CAT scan.

Wrong!

It turned out that it was an MRI scan and an intravenous pyelogram (and how's about that, then? as Jimmy Savile used to say). Be honest, it sounds a lot more impressive than a CAT scan.

Well, the MRI scan took place last Thursday and the urograph (that's another fancy name for the even fancier intravenous pyelogram) was done on Tuesday. Here's just one of the several images taken.

Big deal. Nothing suspicious was found.

Problem is, where do those nasty cells (indicating neoplasm and carcinoma) come from?

Well, whatever is causing them is probably in a very early stage and simply cannot yet be easily detected. Who am I to worry? I know nothing about all this medical stuff, so instead, those that do are going to have a meeting on 27 August to decide what to do next. I think there are two possibilities:

1. Explorative surgery;
2. Wait and see.

Again, we shall see…

Carry on, nurse

Just before being taken to operation

Some time ago a tiny amount of blood was found in a sample of my urine.

A few months later, a new sample was analysed and, once again, a tiny amount of blood was discovered in it.

Dr. A. decided I should see a uroligist, so off I popped within a few days to see Dr. P.

Dr. P. ordered urine analyses at brief but regular intervals during the coming weeks.

Each analysis showed that the urine contained a tiny amount of blood.

Dr. P. decided I should have a cystoscopy. This was a simple cystoscopy, a brief day-visit to the hospital, a local anaesthetic and a flexible tube. The procedure itself was painless. The days after the procedure were not: urinating was extremely painful for several days. Anyway, no immediate cause for the presence of blood was found, but further analysis showed that there were also abnormal cells floating about in my urine.

Dr. P. decided that I should have a second cystoscopy, this time with a day-and-a-half in the hospital, full anaesthetic, and a rigid tube, in order to have a more thorough look and to take samples, including biopsies. The procedure itself was painless (I was well out of it, after all). I was taken to the operating theatre at about nine in the morning and was back in my room at about two. The 24 hours after that, however, were distinctly uncomfortable, with a rigid tube entering my bladder through my penis, and some 18 litres of chlorine solution being dripped in and drained out, providing a constant feeling of wanting to go to the toilet, with the absolute knowledge that this was impossible. I didn't sleep. The next day in the afternoon, the rigid tube was removed, a painful experience that involved some bleeding. I spent the next few days zonked out on painkillers, which helped make urinating less of a torture.

The results of the analyses were received earlier this week: no sign of a bladder tumour, no sign of tumours in the urethra, but more abnormal cells and blood found.

It seems possible that there is something wrong with one of my kidneys. Yesterday I had an MRI-scan with contrast and on Tuesday I am to have a CAT-scan, also with contrast.

After that?

We shall see…