7 January, 2000.

Dear Mr Hooper,

Thank you for the message, as I said on the 'phone I do remember the case well, even though it was a long time ago. Srila Prabhupada first presented to me in the emergency room of Watford General Hospital in 1977.He was in obviously poor health and showed signs of renal failure and was found to be diabetic. These diagnoses were made on clinical suspicion confirmed by blood and urine analysis.

His most obvious problem on admission was urinary retention. This was caused by a most unusual degree of phimosis.That is a long-standing scarring and thickening of the foreskin such that he was by the time of his admission virtually unable to pass urine. This process would have taken many years to develop and during that time could well have produced back pressure enough to result in renal problems - as more often happens with prostatic obstruction.

I remember him as an amazingly calm and stoical person. He refused to be admitted to hospital and I am sure he would not have withstood a general anaesthetic. Somehow we persuaded him to have a circumcision to relieve the problem, which I carried out in the ER under local anaesthetic. He made a good recovery from this and was able to pass urine normally following the procedure.

Unfortunately his renal failure was by that time well advanced and irreversible, caused by a combination of diabetes and phimosis.

I hope this is of some help,
My best wishes,

Andrew J McIrvine FRCS
Consultant Surgeon