BPH Adventures

Usually a good way to digest this narrative will be to simply read it in the order in which it's presented. However some readers will prefer to skip directly to the cost information, which includes several complaints about medical costs in the U.S., including the difficulty of determining costs in advance (before selecting a procedure).

It's common as males grow older for their prostate gland to get a little larger. This is neither externally visible nor painful, but it does have a significant negative effect: because the urethra channel goes right through the prostate gland, it can become quite difficult to finish peeing (or even to start for that matter). The medical community calls this syndrome BPH (the acronym is for Benign Prostatic Hyperplasia) or more informally enlarged prostate. I just call it old man's disease.

Dealing with this problem used to be a little bit tricky -very occasionally involving significant side effects- but it needn't be any more. Mild cases are handled with alpha blocker drugs. Medium cases are handled with an infrared heat treatment. And the most significant cases -which just a few years ago were handled everywhere with a relatively simple surgical procedure called TURP- are now in some parts of the country handled with even simpler laser surgery. Because there's no scalpel to possibly nick the wrong thing, and little tissue damage, side effects are rare. BPH surgery needn't be the potential nightmare it was only a few years ago.

This surgery method, new within the last decade or so, is often called green light because the laser that's used generates green-colored light. The green-colored light, being the complementary color to red, is preferentially absorbed by blood, which makes the laser cutting tool self-cauterizing. The laser is inserted through the urethra; the surgery doesn't need an incision and so doesn't leave any mark. It's generally performed quite reasonably as day surgery, with no need to stay in the hospital for even one night. When a nurse in double-checking asked me what kind of surgery I was in for, I used the decidedly non-medical and rather crude terminology roto-rooter. The nurse laughed and said that vernacular was fairly descriptive of the process.

My Own Case

I've had more and more problem with BPH for well over half a decade. Every night found me getting up and going to the bathroom several times. Having only five minutes between the first warning tinges and I can't hold it any more curtailed my hiking and exploring. Not being able to start peeing readily even when it was clear I had to go frequently kept me in the bathroom for over half an hour. And having it be prudent to pee twice before going out made simply leaving my apartment into a major undertaking.

Besides all that, it seems I have a genetic predispotion toward serious BPH problems; my father had so much trouble with peeing he was one of the very first to undergo Green Light surgery when it was just starting out. All in all, surgery had seemed the obvious option for me for several years.

I did have some confounding factors though. I probably have significant scar tissue in my abdomen, because I was born with a hernia and had it repaired surgically when I was only fourteen months old. I'm very large, and even worse am overweight. And for some unknown reason I have very weak leg muscles and possible related issues.

Perhaps for some of these reasons, or perhaps for other reasons, my BPH surgery was not a complete success. There was no infection, even less blood than expected in my urine, and no side effects. Several symptoms began improving for about the first six weeks after my surgery (although a few symptoms, in particular the urgency of having to go right now, never improved anywhere near as much as I had hoped). But then any further improvement of any symptoms stopped. Just to be clear: I've had no side effects nor new problems; I just expected more than I actually got in the way of old problems going away.

Cost

Although BPH surgery had seemed the obvious option for me for several years, I kept putting it off because of the cost issue. I didn't want to undergo something I couldn't pay for, and wind up having to declare bankruptcy. Unfortunately it was virtually impossible to find out in advance just what the surgery would really cost me. I eventually got a medical bookkeeper in an unguarded moment to disclose some of the true costs and how they were calculated, making it seem I could afford the surgery. That information turned out to be woefully incomplete, but fortunately the actual cost turned out to not be beyond my ability to pay.

Apparently it's almost universal in the U.S. for different patients with different insurances to pay vastly different amounts, so medical professionals have learned to keep cost information to themselves. And even if medical professionals weren't so reluctant to discuss costs, none of them seem to be aware of the true total cost anyway. A patient will receive several different bills from different organizations, and it may not be clear which parts of which bills are related to the surgery. And the insurance statement probably will not exactly align with the bills. This applies not just to BPH surgery, but to nearly all medical procedures performed in the U.S. I find it quite crazy: how can we possibly control medical expenditures if we can't find out how much something is going to cost?

I wish I had been able to choose a tradeoff between cost and comfort that was appropriate for me. Of course in any case I would want every one of the options to minimize infection and to provide adequate medical staffing. But for a lower price I could have skipped the free coffee, modern decor, surfeit of plush chairs, carpets cleaned every day, flat panel TVs, and continuous real-time patient status display in the large waiting area. I would have recovered quite nicely even without so much post-op nursing attention. And so on.

There's a common feeling that when providing medical care, cost should not enter into the decisions at all: simply the best medical care should always be provided regardless of cost. Well it appears that's exactly what we've now got. Our schools and other public institutions are being destroyed by the ever higher spiraling costs of medical coverage. Maybe we'd be better off providing the best medical care we can afford in each individual case.

Here -hopefully for the benefit of some who come after- are the actual costs I had to pay. I show seven separate rows for the single surgery because I received seven separate bills. Note that the net costs to me were fairly low because my insurance had been aggressive about negotiating low rates. Also note that by far the highest cost would go to a patient with no insurance at all; they'd have to pay over fifteen times what I did. Take those least able to pay and charge them the most??? This is nuts!