RSS feedRecently a patient of mine developed acute retention of urine (inability to pass urine) after surgery and required placement of a catheter (a tube placed into the bladder). After giving him an oral medication to treat an enlarged prostate, the catheter could be removed and he managed to pass urine spontaneously. However, he continued to have symptoms of an enlarged prostate (which he had been experiencing for more than a month prior to the surgery), such as poor urine flow, passing a small amount of urine each time and difficulty initiating the passage of urine. He was referred to a urologist who advised an operation to widen the original channel through the prostate gland (called TURP) so that his urinary symptoms would disappear. After the urological consultation I advised him to have the surgery right away. He hesitated and told me that he would like to see someone older since the first urologist looked rather young. After seeing the second urologist, who also advised surgery, the patient returned to see me and said he was not sure.
He was concerned that after the TURP he had to rest for 2 weeks before he could start his chemotherapy. He was toying with the idea of not having the operation and starting the chemotherapy straight away. If in the middle of his chemotherapy he developed urine retention then he would have the operation. I advised against this because the side effect of one of the chemotherapy drugs being used would increase the risk of bleeding from the operation. Despite repeated explanation of the reasons why having the TURP now would actually save him time and trouble in the long run, he still was not sure. He was still concerned that the TURP would cause him a 2-week delay in commencing his chemotherapy.
Subsequently, he asked his oncologist to refer him to another urologist. The third urologist suggested a short course of antibiotics because some of the symptoms could be due to a low grade urine infection after the insertion of a catheter. (Urine infection after the placement of a catheter is a known possibility.) After 5 days of antibiotics the urine symptoms were no better. He returned to see me still asking “Is TURP still the best option?” and to which I answered “Yes”. A few days later I was informed by his wife that he just had the prostate operation under the third urologist.
From the day I advised the patient to have the TURP till the actual TURP, there was a lapse of 10 days! Now he has to wait another 14 days before he can start his chemotherapy. This translates into a 24-day delay from the day he was first advised to have the TURP to the day he can start his chemotherapy. If he had decided straight away after the first urological consultation he would only have delayed his chemotherapy by 14 days.
Sometimes it can be difficult for a patient to be objective and be able to see the wood from the trees. When you are too involved, you can be distracted from the big picture. In this case, the patient was too wrapped up with the thought that if he underwent TURP right away he would have to delay the chemotherapy by 14 days. He failed to realize or ’see’ that his hesitation and his desire to see more urologists, hoping to find one who would tell him that surgery was not necessary, actually would lead to a longer delay in commencing his chemotherapy.
Whenever I meet such a patient, I think of the age-old saying ‘Procrastination is the thief of time’. How true, how true!
