On the Phone

I decided to somewhat change my strategy. I googled for all urologists within a 50 mile radius from my location. For the last two days I have been calling their offices with just one question, ‘Does your doctor perform preputioplasty?’ By midday today I became pretty sad as every single office replied with a no. I was ready to increase the radius for my search options when I received a phone call from Dr. Neil Baum’s office.

‘Yes, I can do that,’ the doctor said. ‘Would you like to set up an appointment?’

‘Sure!’ I replied.

My first meeting with him is scheduled on February 24, 2012.

Second Visit to Dr. Prats and What I Think About Doctors

Today was my second visit to Dr. Prats. I had printouts from Wikipedia and scientific journals about preputioplasty with me. Still, that was another five minute meeting. I asked Dr. Prats what he thinks about preputioplasty. From his expression (What?!), I could tell that was the first time he heard of it. Without even looking at the studies, he told me that for him it is ‘an excuse to charge more money’ and that he does not believe in preputioplasty (he could not repeat the word, of course, since he had never heard it before). End of conversation.

…Wait a minute. You either don’t know what it is and therefore have no opinion, or you know what it is and disapprove.

Doctors are scientists. I am a scientist myself. The are supposed to know research related to their area of expertise. They are supposed to be on a constant watch for new treatments and methods. I understand that it is impossible for them to know everything. But then at least they shouldn’t be blind to new knowledge and in no way should they ignore it in front of their patients. They may get themselves familiar with it and disapprove or not use in their practice. But they should not ignore it!

A lot of medical problems stem from the fact that people are afraid to share their concerns with anyone, sometimes including doctors. This is especially common in urology. ‘Don’t be ashamed. Talk to your doctor’ seems to be the most common piece of advice everywhere. No matter what a medical condition is, every source recommends first consulting with a doctor. Doctors seem to be like angels that help people in most desperate situations, they are remedies to most complicated conditions, and solutions to seemingly unresolvable problems. They are viewed by many patients as the last resort and the last hope. Doctors always care about their patients, doctors always think about them, doctors always understand their problems, and constantly try to do the best to help them. You may be afraid to tell your family about your delicate problem, your friends may be indifferent, but doctors will always understand.  I am pretty sure that in the vast majority of cases doctors are indeed like that. We all share so much respect to them and are so much thankful for everything they have done.

But then it hurts even more when you realize that this particular doctor turned out to be ignorant to your problem. This particular doctor made you feel stupid when you were most vulnerable. This particular doctor showed that your delicate problem is unimportant to him. This happened to me with Dr. Prats. I understand that he treats patients with terminal illnesses on a daily basis. I know that people are in constant urgent need of his help. These are people who have problems with urinating, pain, urinary tract infections, prostate cancers and erectile dysfunctions. Compared to their problems, my problem seems unimportant. But it is important to me!

I was brave enough to come, to talk about my symptoms to at least five people of his staff, and to drop my pants in front of him. I have been searching on-line for days to see my options (this is part of his job, actually). And all that so that he can tell me, ‘I don’t believe in per..put…whatever it is’? Preputioplasty is not a god to believe in it. Can you tell me why? Why exactly do you disagree with these studies? Why do you think I brought these printouts to you? I may be one thousand times wrong about preputioplasty but I do deserve an explanation why you think so!

At least Dr. Prats openly told me that he does not perform the procedure and he only performs full circumcisions and frenulotomies. I guess that was the real reason why the conversation was so short. It is simply easier to stick with what you know.

I changed my mind about having frenulotomy with Dr. Prats, cancelled, and left the office.

Puzzled

The day of the procedure is getting closer, but I am still puzzled if frenulotomy will help me. I cannot help it noticing that the tight ring of foreskin and the frenulum are not even connected (see my pictures in the very first post). Cutting the frenulum may help somewhat, but the ring will still be pretty tight, I think.

At the same time, I started reading more and more on the Internet about preputioplasty. Still not much information from guys who actually had it but in theory it seems like an interesting option. Here is what Wikipedia has to say about it:

http://en.wikipedia.org/wiki/Preputioplasty

Interestingly enough, the picture of the penis that is attached to the article on Wikipedia shows exactly my symptom: the “waist”, or the “bottle neck” shape of the penis. Here is that picture from Wikipedia:

I am still in the process of finding out all of the details about preputioplasty, but it seems like it is aimed to treat exactly my problem and is an outpatient procedure (limited invasion, unlike circumcision and dorsal slits). More importantly, no foreskin is removed. I am scared a bit about possible decrease in sensitivity in that area. With preputioplasty, the foreskin just gets somewhat shorter after the procedure (which is fine with me, as mine is pretty long) and wider (that’s what I need!).

I also found several scientific studies about preputioplasty (just not trusting Wikipedia completely), to make sure it is a real thing. Here are some of them:

http://www.cirp.org/library/treatment/phimosis/cuckow/

http://www.cirp.org/library/treatment/phimosis/decastella/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539601/

http://www.rcsed.ac.uk/journal/vol44_5/4450030.htm

It seems like urologists around the world recommend it for my condition. I am still surprised why there is so little first-hand experience on the Internet about it. But it is now definitely a question I want to ask Dr. Prats…

Preputioplasty

I decided to post a note here about what preputioplasty is. Most of the material is copied from public web sites.

Preputioplasty is also known as ‘prepuceplasty.’ It is a surgical procedure which is performed to widen the foreskin to enable this to be pulled back. The foreskin is too narrow which is due to a tight ring of tissue called a ‘stenosis’ which prevents it from being retracted. This stenosis forms a ‘waist’around the foreskin which prevents it from being pulled back from the  head of the penis (glans).

Preputioplasty is performed under anaesthesia and involves the surgeon making two vertical incisions in the foreskin to release the stenosis. These are then closed using stitches but this will have widened the foreskin which means that it can be retracted.

There is another option to stitches which involves using a heated probe which seals off any bleeding. Another option is bipolar diathermy which uses electric current to do the same thing.

This procedure is used to treat phimosis and is an alternative to circumcision. It is seen as less invasive, less traumatic and quicker to heal than circumcision.

Another similar procedure is a dorsal  slit which involves making an incision in the foreskin to help loosen  it and widen it at the same time. This single incision reveals the glans  but does not involve any removal of tissue. This is less commonly performed in  favour of preputioplasty.

First Visit to Dr. Prats

Today was my first visit with the urologist, Dr. Prats. Another “Hello.-How may I help you?-Drop your pants for me, please.-I see.”-kinda visit. The whole visit took no longer than 5-7 minutes. The doctor at least told me that my condition is not serious as long as I can open the head of the penis. Then he told me that no cream can help me. That was good to know since I just finished treating myself for two months with the cream his office prescribed! He also told me that I have three options: to live with it the way it is, to have a full circumcision, or to have a frenulotomy (a procedure when a doctor cuts the frenulum of the penis). His personal opinion was that my problem is caused by a tight frenulum, and that cutting it would help a lot. I do have a short frenulum, that’s true. But I’ve had it that way all my life. Yet, until recently, I had no problems with retracting my foreskin. Also, I do not notice any change with the frenulum itself.

Dr. Prats scheduled a frenulotomy at the end of February. Frenulotomy is an outpatient procedure. He reassured me that I will be able to go home just hours after the procedure.

So, what do I feel now? I do trust his medical expertise, and I am pretty sure he will do a wonderful job with the frenulotomy. I just don’t feel like there is anything wrong with my frenulum. A completely different part of the foreskin bothers me and hurts when stretching (more on top than on the bottom of it). Also, the frenulum is the most sensitive part of my penis (in a good way). I am puzzled.

Halfway Through Treatment with Cream

I have been applying the cream twice daily, as prescribed. At first I wanted to document everything on this blog. How my symptoms would go away slowly day by day. In contrast, I have a feeling this is going to be the only post on this topic. I notice NO CHANGE whatsoever. I put the cream on my foreskin before I go to bed and then again in the morning after shower. Day after day. With absolutely no result. My foreskin is still as tight as it was. No change in color patches either.

Since it takes weeks to wait for an appointment with a doctor, I am about to schedule one today. By the time the two-month treatment with the Betamethasone cream is over, I will be ready to discuss my options with the doctor.

….scheduled for January 26, 2012.