The Birmingham Prostate Clinic is a national centre of excellence providing advanced treatment for the prostate, bladder, penile and urethral conditions. Read the blog to find useful information on prostate cancer.
“Richard King: Greenlight laser treatment for an enlarged prostate has changed my life.”
“I think the symptoms of having an enlarged prostate must be quite like losing your eyesight: it is something that gradually creeps up on you, affecting your life in so many ways. I had to give up work, even though I ran my own business and I didn’t want to retire. But my business was motorway accident recovery and it’s an impossible job if you need to find a toilet every five to ten minutes.
The embarrassment in a public toilet was terrible: I’d stand there for ten minutes with no more than a dribble. You knew people were looking at you and wondering why you’d been standing there for so long. It affected me deeply – I’d have anxiety attacks thinking about the embarrassment and worry.
When I went to my local NHS hospital and explained that I couldn’t pass urine, I wasn’t offered any assessments or treatment. I was just told that I’d end up wearing a catheter for the rest of my life. My three daughters are all nurses and no-one in the family accepted this.
I did my own research online, reading about GreenLight laser surgery for the enlarged prostate and that was how I came to Mr Doherty at the Birmingham Prostate Clinic. He quickly diagnosed the problem and how to deal with it and I had absolute confidence in him. I had my GreenLight laser surgery at the BMI Priory in Birmingham a year ago. I can’t fault Mr Doherty, or the excellent care I received in the hospital.
I spent a night in the hospital and the following day tried passing urine without a catheter. Immediately, I had a good flow and over the weeks that followed, it got stronger still. I don’t remember having pain or discomfort of any significance.
I’ve just been on a motorbike tour of the Scottish Highlands, which is something I couldn’t possibly have done before. When I travel now, I can keep going for three or four hours before I need to stop for the toilet which is world’s apart from the way it was before. Having GreenLight laser surgery has changed my life.
What is also world’s apart is the approach of Mr Doherty and also Mary Kirkham, a Birmingham Prostate Clinic nurse who has supported me throughout. They really listen to what you are saying and care deeply about sorting it out for you. I can’t recommend every part of the treatment and support I received highly enough.”
Mike Clifford came to BPC because of our distinctive diagnostic pathway. This may have saved his life, finding hidden kidney cancer.
“I started having regular PSA monitoring about ten years ago after a slightly raised result. My PSA readings went up gradually and by the time they reached 9.2, I asked my GP for advice. The GP suggested going to an NHS service where I would be seen quickly. The appointment did come through promptly, but I was a little surprised to read I was being invited for a biopsy.
I’d done my own research by then and knew there was more to it than leaping straight to a prostate biopsy; there can be many reasons for a PSA being raised other than prostate cancer and a biopsy is an invasive procedure. The Birmingham Prostate Clinic website explained their approach: MRI first to establish whether there is a need for a biopsy and if this is the case, a template biopsy which is more thorough than the standard transrectal, especially in terms of reaching the back of the prostate. The logic of this made a lot of sense to me.
After my MRI scan, I was given a CT scan. I was then asked to come and see Mr Doherty the following day. He explained it was a ‘good news and bad news’ scenario. The good news was there was no prostate cancer: the cause of my elevated PSA was most likely to be some prostate enlargement. The bad news was the scan showed I had a four-inch tumour on my left kidney. A nephrectomy was recommended (complete removal of the affected kidney).
If I had gone down the NHS route, I would have had a biopsy of my prostate which would have come back clear and I would never have known about my kidney cancer. I had no symptoms whatsoever; it would have remained undetected.
I had my operation in April (2019). Thankfully, my cancer was contained with the kidney and Mr Doherty was able to remove the kidney, adrenal gland and lymph nodes and achieve complete cancer clearance with clear margins. People say – you are lucky. It feels like a funny kind of luck, although of course I am relieved my kidney cancer was discovered. A nephrectomy is a major operation so has taken some recovery time, but I have a positive, pragmatic approach to things. I’m glad the cancer was identified and once it was, it had to be dealt with.
PSA monitoring shows how a little knowledge can be a dangerous thing; there are 101 reasons why a PSA level may be elevated. My working life was as a captain in the Merchant Navy: when you are dealing with a situation, you need to have all the information and context. That was the advantage of the Birmingham Prostate Clinic: I was convinced by the MRI first approach and by the template biopsy, if a biopsy was required. I was also impressed by the nerve-sparing approach to prostate cancer surgery, if that had turned out to be what was required.
In conclusion, my experience shows the importance of seeing a specialist who can put everything into context then act accordingly. There is no point in thinking ‘what if’ but I am very glad to have taken the diagnostic route that I took and to have dealt with a cancer which could easily have remained undetected.”
Theranostics and prostate cancer, by Alan Doherty, consultant urologist and Dan Ford, consultant clinical oncologist, the Birmingham Prostate Clinic.
You may have heard of a new term in the prostate cancer field: theranostics. The word ‘theranostics’ has been created by combining the terms ‘therapeutic’ and ‘diagnostics’ because the concept behind it is precisely that; the merger of diagnostics and drug therapy to personalise medicine.
Of course, you would be right in thinking there is always something ‘new’ in prostate cancer, typically heralded with newspaper articles, studies and exciting claims. In fact, you would be wise to take this savvy approach; there is always something proposed as new and promising in prostate cancer. At the Birmingham Prostate Clinic, although we have always sought to offer patients access to proven, effective advanced treatments and assessments, we have avoided ‘jumping on the bandwagon’ of every new offer. Careful evaluation is always needed.
We had our first experience of the diagnostic side of this approach in prostate cancer in 2015. It was for a specific cohort: patients who have had primary treatment (usually surgery) but have a rising PSA (prostate specific antigen), indicating there is likely to be disease relapse. For a significant number of these patients, the relapse occurs on a biochemical level which is not evident on standard scans.
We began a collaboration with a centre in Germany providing a specific type of PET scan for patients in this scenario. It involves injecting a substance called a radiotracer into the body which is preferentially taken up by cancer cells rather than normal ones. This provides a ‘trace’ of very small groups of cancer cells on a biochemical level that would otherwise not be evident. In prostate cancer, the most effective tracer for this is called Gallium 68, which binds itself to membrane (PSMA) expressed by prostate cancer cells.
The diagnostic information provided in PSMA-based scans enabled us to apply highly targeted radiotherapy (Stereotactic Ablative Radiotherapy: SABR) and achieve significant disease control, delaying hormone therapy.
The future of theranostics in prostate cancer
The concept of theranostics is based on not only the diagnostic approach we have seen in the PSMA-based scans but in applying the same knowledge of biochemical processes to treatment. 177Lu-PSMA like Gallium 68 is preferentially taken up PSMA on prostate cancer cells. It also delivers a therapeutic radioactive treatment to these cells.
The therapy, 177Lu-PSMA, has been used safely in advanced metastatic prostate cancer for around 3,000 patients overall, mostly in Australia and Germany. The largest study published thus far involves 500 patients (with castrate-resistant prostate cancer). Findings after three to four cycles of 177Lu-PSMA are as follows:
40% show a reduction of more than 50% in PSA level
30% show 0-50% reduction in PSA
30% show progression despite treatment
Progression-free survival of 6-21 months
Overall survival benefit of 6-14 months
Theranostics and prostate cancer: impact
Should theranostics, therefore, be considered the ‘new big thing’ in prostate cancer? It is important to maintain the caution underlined at the start of this discussion, however, that said, theranostics does seem significant. Keeping in mind: although the outlook for men diagnosed and treated for early-stage prostate cancer is very good, the other side to the story is that many are treated late and one in three men with have biochemical relapse (rising PSA) within ten years. For this significant group, theranostics does seem to be important.
We have long recognised that it is unsatisfactory if a patient has rising PSA, but standard scans are not sufficient to identify the location of cancer spread. The patients we work with, who were initially willing to travel to Germany (PSMA-based scans are now available in London) wanted the opportunity to treat recurrence at an earlier stage with more precise, targeted treatment. This seems entirely understandable and underlines exactly why theranostics is potentially an impactful, valuable new approach.
At the Birmingham Prostate Clinic, although we do not currently provide theranostics, we do have patients who have had PSMA scans and we are exploring the establishment of a clinical trial. We are happy to provide advice and guidance to patients.
“I had been struggling with stress incontinence for many years, since giving birth to my two sons. I tried pelvic floor exercises, medication and injections, but none of which were successful, and the stress incontinence just seemed to be deteriorating. Having a mesh sling implant was suggested and described to me as an easy option; It would be a day case procedure, so I would be back home on the same day, as long as there were no hitches, and fully recovered within about four weeks. I did have some reservations, generally with having surgery, anaesthetic or anything going wrong, but these were quashed by the doctor, this was September 2016, just before problems with TVT/TOT mesh implants became widely publicised. I wasn’t aware of any medical issues with the mesh, and felt no need to research the surgery on the internet. I purely followed the advice of my doctor.
The surgery was effective in terms of my incontinence, and I made a good recovery. It was some nine months later, in the summer of 2017, when I started to feel niggles in the top of my inner thighs and some lower back pain, particularly the area around my sit bones. Within three months it had intensified into lower abdominal pain, which felt like severe period cramping. It was very debilitating: I lost a stone-and-a-half very quickly because I was in so much pain. I had no appetite, spent days lying on the sofa and counting the hours until I could take my next pain relief medication.
From early on, I suspected the pain was being caused by the TOT mesh implant. I saw different doctors at the local surgery on numerous occasions, but all dismissed the possibility that the pain was caused by the mesh implant. I was admitted to hospital as the GP’s just didn’t know what was causing such pain. Over a few months, I had an X-ray, CT scan, colonoscopy, laparoscopy to check for endometriosis. During this whole sorry period, I was prescribed many anti-inflammation and pain relieving medications. I decided to take the matter in my own hands and seek help from a consultant in London, who carried out an endoscopy, which showed the toll my stomach had taken with the pain medication, but not the cause of my pain. This was the first person who’d really listened to me, he thought the issues I had were highly likely to be associated with the mesh. I did my own research and found an online group for women who were having problems with mesh implants. There was a list of eight surgeons in the UK who could carry out mesh removal. Mohammed Belal was not the nearest surgeon to me, but his biography appealed to me the most because it seemed very honest.
I first saw Mr Belal just before Christmas 2017, with scans arranged early in 2018. They showed that my implant was intact but causing extensive inflammation in my nerves, especially on one side. Travelling to Birmingham was made as smooth and easy as possible by Mr Belal’s secretary Louise who went to great lengths to ensure my appointments fitted in with my travel arrangements.
The operation to remove the TOT mesh was successful, about 90% was removed, but the recovery was long and slow, taking about five months due to the nerve damage that remains. I continue, and will probably always need to take medication for nerve damage.
After this procedure, my incontinence returned to a more severe degree than before. I had been told that this may be the case, but to have time to heal, and then we would take one step at a time and decide what action to take next. It was thought to be better to have time to recover from this mesh removal procedure before having the autologous implant (the sling made from your own body’s tissue). So, although this period was challenging, I was prepared for it, which was very important. You need to be kind to yourself and not expect miracles overnight. It helped me to realise that Mr Belal was using a scalpel and not a magic wand!
I had my second procedure in October 2018, when fascia (tissue) was taken from the pubic bone area to construct a sling from your body’s own tissue. Your own tissue is used to create a sling and because this is your own tissue, it doesn’t cause rejection and inflammation. Few surgeons are trained in this procedure, unfortunately, because of the past emphasis on using TVT/TOT mesh.
There was some discomfort after my second procedure, but the main challenge was that I had to self-catheterise for three months. I knew this was a risk; again, I had been warned this was possible, and it felt like just my luck that I would be in the minority affected. I was very grateful to have the support of Mary Kirkham, an advanced nurse practitioner at the Birmingham Prostate Clinic who gave practical guidance and was always there for me, a phone call away, whenever I needed advice.
I went back to the clinic for my final appointment (March 2019) Mr Belal commented that I was a different person: I am generally pain and discomfort free. I am dry and no longer need to catheterize; I’m back to living my life and making the most of it. It has been a really long and hard journey and I am very grateful to Mr Belal and the whole team at the Birmingham Prostate Clinic, I am reluctant to say goodbye.
My advice to others would be: go and see a specialist in this area. Many doctors just don’t seem to have the knowledge for diagnosis, and it is very important that you see someone who does. I know what it is like to be stuck lying on the sofa unable to do anything else because of the pain you are in. Don’t wait or delay: start your journey to recovery.” Looking back, now armed with much more information, I wish I had pushed harder at the outset to see a specialist in this area, trusting my gut feeling.
The overactive bladder is a very common problem, affecting an estimated one in eight adults in the UK, particularly during later age. If we think of the bladder as effectively a bag of muscle, an overactive bladder occurs when those muscles contract suddenly without control, even when the bladder is not full. Urge incontinence is a term that is used interchangeably with ‘overactive bladder,’ although it has a specific meaning: urge incontinence means the sudden contractions of the bladder cause leaking of urine.
In this article, we consider how technological developments may be applied to overactive bladder devices used to help people with the most severe form of this problem.
What is the overactive bladder?
People with an overactive bladder experience a sudden and overwhelming urge to pass urine. This can occur when the bladder only contains a small amount of urine. Normally, the bladder starts to send signals to the brain from the stage when it is approximately half full. With an over activity, signals are sent from the bladder to the brain when there is very little urine in the bladder and often when there is a certain trigger, such as a person reaching their front door and putting keys in the lock.
Most common overactive bladder treatments
Treating the overactive bladder and urge incontinence always commences with the least invasive approach which may be effective. Usually, this means starting with your diet and drink intake and whether this can be modified. For example, reducing or cutting out alcohol and caffeine may be helpful and looking at times of day when you drink. It is very important, however, not to restrict fluid intake so much that you become dehydrated (this is something people often do and remember, dehydration presents its own risks). Bladder training is also commonly used as a first step for overactive bladder treatment, using techniques to help you last longer between visits to the toilet. Pelvic floor exercises can be very helpful. Medication to relax the muscles in the bladder is prescribed to people with urge incontinence if the first-line treatments are not success. Medication can be very effective, although some people are troubled by side-effects.
New technologies and devices
For some people who have tried all the different types of overactive bladder treatments discussed without success, an approach called sacral neuro stimulation may be considered. The principle is using electrical currents to reset the faulty signals the brain is sending to the bladder, telling it to empty immediately. During a short surgical procedure, a thin wire is implanted in the lower back (where the sacral nerves are located). The wire connects to a controller which sends electrical signals to the nerves, with the aim of interrupting the signals of the overactive bladder. When the overactive bladder device is first implanted, there is a process of adjusting the level of the electrical current, so it is effective. The current is painless are barely noticeable.
Currently, people using this sort of device wear a controller, usually in belt worn around the waist and additionally, there is a control unit which is used to set and change levels of the electrical signals. The rapid development of mobile phone technology has great potential in this area, with developers looking at how a smart phone could replace the control unit; a more convenient and discreet way of managing levels on the device. There are other advances in development using smart phone technology, such as the phone automatically recognising when a person is asleep and adjusting the level of the electrical current accordingly.
Since the suspension of all procedures to implant
vaginal mesh in July 2018, we are often contacted by patients and professionals
for advice and help. For some patients, this involves surgery to remove mesh for
female stress incontinence because it is causing pain, discomfort and/or
urinary problems. I have carried out about 30 of these procedures currently.
The other issue that we are seeing, increasingly, is
very conservative management of female urinary incontinence resulting, for some
women, in very poor control of urinary symptoms. Few surgeons are trained in the
alternative approach to creating a female sling, known as pubovaginal
suspension or autologous sling which avoids the use of TVT mesh and the
problems associated with it.
The autologous pubovaginal sling uses the patient’s
own tissue (usually this is taken from the lower abdomen). This was the
original approach to surgery to support weak tissues by using a ‘sling’ or
‘hammock’ that sits just beneath the vagina and above the urethra and was the
gold standard before TVT mesh was introduced.
TVT mesh for vaginal implants first emerged about 20
years ago. Because this was a less invasive operation for the patient and
simpler operation for the surgeon, it became the first line option in most
cases and an operation carried out on a wide scale: more than 92,000 women received a
vaginal mesh implant between April 2007 and March 2015 in England alone.
This meant surgical skill in the autologous pubovaginal
sling procedure was depleted. Within the West Midlands region, I was the single
surgeon who would receive referrals for any patients who would be better suited
to an autologous sling, while other urologists within the region specialising
in the treatment of stress urinary incontinence would carry out mesh implant
operations only (which was the choice for the majority of patients).
The suspension of mesh operations has left us with a gap in surgical options for women with moderate to severe stress incontinence and prolapse. I am now involved in training a number of colleagues in the autologous approach, but this will take time. While more surgeons train in the autologous approach, very conservative management is common. Other interventions may not suit the woman with moderate to severe incontinence: colosuspension (surgical lifting of the bladder) is major surgery and using urethral bulking agents will not be effective for some patients. We also increasingly are asked for advice and guidance by women with mesh implants. I emphasise that if you are asymptomatic (no pain, no difficulties passing urine or repeated infections), it is best to continue as you are. It is understandable that the suspension of mesh implants and accounts in the media may make you feel anxious. Do seek help if symptoms arise, but we would not remove mesh unless you were symptomatic.
In recent years, there have been some very positive developments in the prostate cancer field for men with advanced disease. One of these is a new approach for patients with oligometastatic disease (sometimes also known as early metastatic disease). To start with a definition: oligometastatic disease is the term used when there is some distant relapse (secondary cancer in another part of the body away from the primary site), but in a small number of locations, at an early stage which is amenable to treatment. We are changing the way that we understand and explain oligometastatic disease: moving away from an end-stage prognosis that can be frightening and/or difficult for patients and considering it more like a chronic condition which will not be cured but can be managed and controlled in a number of ways.
One of those management approaches is Metastases-directed therapy. This is an option that has become possible thanks to advances in imaging technology. The scenario is this: patients have had primary treatment but a rising PSA (prostate specific antigen) indicates treatment has not cleared or fully controlled the disease. Nor do they have full metastatic disease; the distant relapses are usually too small to be visible on bone scans. Advances in imaging mean we can offer these patients a PET (Positron-emission tomography) scan using a special tracer (PSMA or Choline) which can detect metastases even when they are extremely small (e.g. single pelvic lymph node).
Once it became possible to confidently and accurately pin-point very early distant disease, this opened another option for treating distant disease in a targeted way, rather than moving straight to systemic treatments (hormones and chemotherapy). The metastases-directed therapy used is Stereotactic Ablative Body Radiotherapy (SABR) because of the high degree of accuracy it affords.
As with all advances and changes in disease management, it has been important to measure and evaluate exactly what difference this actually makes for patients. I have just completed a study of 18 patients managed using this approach. The aim of the study was to measure: local disease control, biochemical progression-free survival (b-PFS), toxicity (side-effects and complications) and systemic therapy-free survival.
The average age of patients in the study was 68. Previous treatments for the primary prostate cancer included surgery (8 patients), surgery and salvage prostate bed radiotherapy (7 patients), radical radiotherapy (2 patients) and cryotherapy (1 patient). Twelve patients had a single metastatic site, four patients had 2 sites and 2 patients had 3 sites. Six patients were treated with a short course of androgen deprivation therapy (ADT) in addition to SABR. All patients had a fall in PSA with a mean reduction of 75%. At a median follow-up of 14 months (range 2 – 28.5), 14 patients (78%) had good disease control and had not needed to progress to systemic treatment. Three patients with a single pelvic lymph node metastases achieved a sustained undetectable PSA level. All 8 patients who had a post-treatment PET scan showed no residual activity in the treated site. One patient experienced G2 acute bowel toxicity, otherwise there was no significant complications and side effects.
My conclusion is metastases-directed therapy using SABR for relapsed prostate cancer is a safe treatment with promising results in terms of local control, b-PFS and delaying the initiation of systemic therapies. This minimally invasive approach has the potential to improve patients’ quality of life but requires further evaluation in randomized clinical trials.
As a clinic offering nearly all the different treatments for BPH, we are in a unique position to observe how patients weigh up the options; what matters to them and how they prioritise the many considerations involved.
BPH treatment is a field which has seen very rapid changes in recent years: we introduced GreenLight laser surgery at an early stage, back in 2007, and now have a caseload experience of more than 1,000 procedures. GreenLight laser surgery provided the first surgical alternative to the TURP (trans urethral resection of the prostate), which was recognised for its effectiveness, but involved side-effects that many patients found unacceptable.
More recently, other approaches have been introduced, offering options which are even less invasive than GreenLight laser surgery. We have one of the largest experiences in our region in the new approaches UroLift and in Rezum.
We consistently maintain the same position in terms of how we explain and offer the different treatments: we are not enthusiasts for one particular approach over the others. We are committed to good, open dialogue with our patients setting out the considerations for each procedure, its advantages and disadvantages, so they can make a fully informed and personalised decision. What have we learnt so far from our dialogue with patients and experience of all the treatment options for BPH? If your priority is having the most minimally invasive procedure so you can get back to work and/or all normal activities straight away. UroLift is the most minimally invasive option of all. It involves using an implant to lift the two lobes of your prostate apart, creating a space to allow urine to flow more effectively. You will be able to go home on the same day as your procedure (once we have checked you can pass urine normally) and unlike other procedures, you will not need to wear a catheter. Discomfort is usually minimal and addressed by paracetamol, if needed.
Bear in mind studies show UroLift does improve urinary symptoms although not to the same extent as other procedures in terms of degree of impact and durability. You may, at a later stage, need further treatment. It depends how severe your symptoms are and what sort of outcome you want. Patients with a large prostate and three lobes (called trilobar, which refers to a middle lobe) will not be suitable for UroLift. Interestingly, one study showed one in ten patients needed another procedure after having UroLift and half of those chose another UroLift, so providing patients are properly counselled about the procedure, it is well-tolerated and many choose it again, if further treatment is needed.
If your priority is having treatment for BPH that does not affect your sexual function in any way (including dry orgasms) Rezum or UroLift would be recommended, as treatments which do not affect ejaculation in any way. GreenLight laser, in most cases, causes permanent retrograde ejaculation (dry orgasms) due to the changes which occur in the bladder neck as a result of treatment and this means ejaculate flows back into the bladder. Many patients are not bothered by this; the sensation of orgasm is not diminished. But it is a very important aspect if you think you may want to have children in the future and some patients do not feel this is an acceptable side-effect.
Bear in mind you will need to wear a catheter for five to seven days after Rezum, and additionally, for up to four weeks, you may have urinary symptoms including passing debris (surplus prostate tissue) destroyed during the procedure via your urine. The improvement in your urinary flow is gradual, taking full effect at around for to six weeks, once the debris has passed through your body. If your priority is having the treatment that gives you the greatest probability of a full and permanent improvement in your symptoms GreenLight laser surgery is the option we would recommend if permanent and full symptom improvement is your main priority. We regularly undertake GreenLight laser (occasionally with a ‘trim’ TURP if we judge this to be the most effective way of completing the procedure), creating a durable space for urine to flow. You will spend a night in hospital and will come round from surgery wearing a catheter, but this is removed once you are ready and patients regularly find the improvement in urinary flow is immediate and dramatic.
Bear in mind the recovery period from GreenLight laser surgery is a little longer than from UroLift or Rezum, though significantly shorter than from a full, traditional TURP. You must wait 48 hours to drive after having a general anaesthetic (by law) and there will be a little blood in your urine for one to two weeks. You will be able to resume all normal activities two to four weeks after your procedure.
I see a lot of patients who come to me when they pass a stone or need to have a procedure to have removal of one. My heart is with them, as they describe the experience as the most severe pain in their life and they wish it will never be repeated in the future. For that reason, patients are very keen to avoid further episodes of stone passage and want to find out about the stone prevention. This advice is especially important as we also know once a person has developed stones, the likelihood of them having another occurrence is raised to about 50 per cent over 10 years.
There is frequently a lot of confusion around the topic. My advice that the most important part of change which they need is increased fluid intake. It has been proven that if a person has urine output of more than 2.5 litres per 24 hours, they are unlikely to form stones. The type of fluid is not as important, as volume, so it could be pure or flavoured water or diluted juice. Stone formers are advised to avoid black tea, as it contains high amount of oxalate, a frequent component of stones. Citrate-containing drinks, such as lemonade, are useful, as they provide citrate, which is a stone-formation inhibitor, but be mindful of intake of calories with soda type drinks.
A person could judge whether they drink enough fluid accurately by measuring the volume of urine produced over 24 hours, as each individual fluid intake would vary, depending on their activity and ambient temperature. For example, a tall athlete would require fluid input of over 3.5 litres to compensate for sweating during exercise.
If urine dilutes enough, the substances which form stones will not clump together. It will not dissolve already existing stones but will prevent their growth and appearance of new deposits for stone formation.
The other important change is diet. Reduction of salt and animal protein will lead in reduction of propensity to form stones, so goodbye bangers and mash and hello salad.
Calcium oxalate is the most common type of stones. Oxalate is encountered in chocolate, strawberries, grapefruit and spinach, so these foodstuffs are allowed in moderation. The advice to reduce calcium rich foodstuffs, such as milk, is outdated, as calcium binds oxalate in the bowel and prevents it getting into the body.
Increased vegetable consumption is also helpful, as it alters pH of urine to alkaline and makes stone formation less likely, which is important for the other common type, urate.
In conclusion, stone prevention is a question of altering diet and is entirely in the hands of an individual.
“I know exactly when it started because we were at a wedding: on April 14, 2018. As is always the case during a wedding, I was eating and drinking more than usual and ended up going back and forth to the toilet frequently. By the end of the evening, I reached the stage where I was at the toilet, but nothing was coming out.
I went to my GP the next day. He examined me and said my prostate felt normal, but my bladder needed to be drained by a district nurse. The day after that, things were no better, so I had to go to my local A&E where I had a catheter fitted.
Two weeks later, I returned to the hospital to have a trial without catheter (TWOC) but I wasn’t able to pass urine normally. I was told to come back and try again in a further two weeks’ time, although there was no assessment of the root cause of the problem.
It was a chance conversation I had with a friend which completely changed the course of action for me. My friend, who is an osteopath, said: ‘This is no good. You can’t just keep going back and forth to the TWOK clinic and wearing a catheter on a long-term basis.’
He knew someone at the Queen Elizabeth Hospital, Birmingham and asked for advice. The advice was: see a urologist and the best person to see is Mr Doherty.
I called the Birmingham Prostate Clinic; my call was on a Friday and I was offered an appointment on the next working day, on Monday. When Mr Doherty examined my prostate (by physical examination and ultrasound) he found it was very large, so much so, that my urinary flow was restricted and led to retention.
I was relieved to have a diagnosis and Mr Doherty put my mind at ease by explaining the GreenLight laser procedure with a trim TURP, which would reduce the size of my prostate to create space for a normal flow.
I had my operation on May 30. I had a good night’s sleep in hospital and once I woke the next morning, I felt the urge to go to the toilet. At first, I couldn’t pass urine and felt anxious that it hadn’t worked, and the problem had persisted.
By about 11am, it started to work and soon, my flow was getting stronger. I felt no pain or discomfort at all: I was amazed to wake up with no scarring and not even the slightest bit of discomfort.
Within a day of surgery, I was peeing just like I did when I was much younger and I never looked back. After another couple of days passed, I’d almost forgotten that I’d had an operation.
With the benefit of hindsight, I’d say I had known something was wrong, that my flow was getting weaker and I was getting up more at night. But like a lot of men, I’d put it at the back of my mind and worked around it.
What I’ve learnt from my experience is the benefit of getting to a specialist. My GP incorrectly told me my prostate was normal and the TWOC clinic was just a ‘hit and hope’ approach. I am so grateful to my friend the osteopath; if we had not met and talked about it, I don’t know where I would have been. I have since learnt that wearing a catheter for a long period of time causes the bladder to stop working properly.
What I also know now is that the GreenLight laser with trim TURP is a great operation which worked immediately for me, without causing any pain or discomfort.
From the first time I called the Birmingham Prostate Clinic right through to assessment, treatment and follow-up care, I found the whole team and approach absolutely fantastic.”