Nanoknife

I would just like to comment on my post operative experience of the nanoknife procedure and discuss/compare notes with anyone else who has undergone it. It may also be of interest to people considering it. I went through the procedure ten days ago. I don't know if it is too early to comment about side effects, however the procedure is marketed as having minimal side effects compared with more radical treatments. It was a day procedure and it is true that I was able to be discharged wearing a catheter on the same day after showing I could use it and having something to eat.

One side effect which was not brought to my attention at all until the day is that following the operation you have an urge to pass water when you actually don't need to do so. This is extremely uncomfortable. However it would not have deterred me from treatment as such.

The catheterisation was done during surgery and I also found it painful afterwards and a pain to deal with [I don't know how they got the tube into my penis it seemed so large]. It was however fairly easy to use when in place. I live quite close to the hospital so only used the attachable bag twice to go to and from the hospital. I decided not to go out over the weekend anyway and would not have been able to due to the persistent urge to urinate. A bag was provided to attach the manual tube to so you did not have to get up to urinate during the night. However I decided not to use this with the result I was going to the toilet every half hour and could not sleep. I doubt I would have slept however even if I had attached it. I experienced soreness and pain in the glans [head of penis] at the intersection with the catheter every time I passed water.This persisted throughout the weekend.

This surgeon only required it to be in from Friday until Monday, when I attended hospital to have it removed [and afterwards have an MRI]. The nurse was quite good removing it though it was sore. I then had to drink a lot of water and demonstrate I could pass water without the aid of a catheter, which was OK. I had a pad put in in case of leakage going home, however I live quite close to the hospital. Main side effects afterwards were urgency, frequency and pain when passing water and sometimes urgency but unable to pass water. 

Things became more alarming the following [Tuesday] morning. I only had a couple of hours sleep but after getting up there was serious urgency with no ability to pass water or only in dribbles and with considerable pain. I'm told this is a matter of gravity - after lying down it takes time for urine to pass from the bladder through the urethra when you are vertical. Nevertheless it is very distressing [especially until you are told the reason]. Obviously throughout the first days after the catheter is removed the spectre of urinary retention with no ability to urinate at all looms and the potential need for re-catheterisation or attending A&E. Fortunately I was determined and able to get through without this. I feel re-catheterising would just have extended the problem.

Situation for the next few days from Tuesday remained the same. Very frequent urge to go with small passage of urine requiring further visits soon afterwards. I would say during this period I was visiting the toilet every half hour. This included at night as I decided it was better to stay up rather than try to sleep but have to get up every half hour with the added problem of gravity described above causing inability to pass water. I admit not putting in the overnight bag may have made things more difficult for me. Difficult to say now. I don't think I would have slept with it attached anyway.

Things began to get slightly better by Thursday when I was able to pass rather more volume, however, the urgency and frequency continued. I spoke to the hospital nurse daily throughout but decided it was better to try and work through the problems than go back to square one with another catheter insertion. My thinking was also that maybe my expectations for recovery after less than a week were perhaps over optimistic. By Friday I found the urgency/evacuation frequency was marginally less and volume rather more. By this I do not mean a huge improvement but frequency every hour rather than half hour, and ability to get a bit more sleep. Pain on evacuation remained a major problem. Imagine knowing you have to do something which you know is going to cause you agonising pain in a very sensitive organ. Sometimes I could get away with longer intervals however it reduced my confidence to go out and I had to cancel one engagement.

Since Friday I would say things are continuing to get marginally better. But usually there's need to urinate two or three times during the night and two or three times within a short period after getting up. Urgency usually arises whenever I get up after sitting. I continue to experience sometimes agonising pain at the tip of the penis when urinating. As this does not affect the abdomen or lower urethra I put it down to trauma from the catheter insertion, also as it is a continuation of a problem when the catheter was still in. GP is arranging urine test however to test for infection. I can evacuate and the volume is getting more and the flow more but a very thin flow compared to pre-operation.

As I am now into week 2 following the operation I am hoping there will be further, if slow, improvement.  So main problems:

Urgency particularly on getting up from sitting or in the morning. This is now becoming a more serious issue as it limits my ability tp go out. No incontinence however this is because I don't go out much and therefore am able to get to the toilet! I wear a pad as a precaution, which I was told would not be necessary when I asked before the operation.

Pain in the penis when urinating.

No blood in urine I'm aware of. No sexual function so I don't know if there would be blood in semen [as there was post biopsy].

This is an interim report. However I wish to  make the point that based on my experience there is too much downplaying of the immediate after-effects of this procedure. As noted above, I was not informed at all of the very uncomfortable "urge to go without being able to urinate" until in the hospital!

It is obviously too early to give a verdict on whether the long terms side effects of urinary problems, ED etc are as minimal as we are told to expect. However the short term side effects should not be underestimated based on my experience. Particularly as the impression is very strongly given that this is just a day procedure with a couple of days on a catheter [the effect of which most men don't know about as they haven't previously had one] after which all will be well. Rather like the discomfort of going to the dentist for a filling where it resolves by the following day. As noted above this is very far from the case.

The impact may vary according to the individual and some may be more sensitive physically and/or mentally than others to the problems that do arise. However for me these were/are seriously distressing, painful side effects. A few days' supply of basic medication - anti-inflammatories, antibiotics - was provided, however with very little discernible effect. Told to get ibuprofen thereafter! Fortunately I was able from my own knowledge to supplement these with tamsulosin [which in my view was really an unforgivable oversight by the hospital in this situation], painkillers and a stronger [but expensive] anti-inflammatory. It is also necessary to continue the medication longer than the hospital's meagre supply. 

As things stand the above would not have deterred me from having the operation, given the longer term profile compared with more radical treatments. A certain amount of risk is entailed when assessing any treatment and I did do extensive research before following up this treatment. Ultimately however you never know what you will have to contend with until you actually experience it. Nevertheless I consider more details of the short term side effects to expect in practice would help men to prepare better psychologically. Also how short is "short term". AFTER the operation I am told it could take some time - even weeks - to resolve. No doubt my ten days is relatively short, though not compared to the one or two days highlighted by the marketing! Obviously better than the time post prostatectomy or radiotherapy. But is the degree of side-effect that different from these? [allowing that incontinence is unavoidable for the former].

I would be interested to hear of the experience of anyone else who has undergone this procedure. I will try to update this report in due course.