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User
Posted 09 Oct 2024 at 00:35
I want to share my recent prostatectomy surgery. We all hear about having nerve sparing surgery but their are now even more advancements in the surgery.

 

I was dry with no leaking immediately after the catheter was removed. The latest DaVinci Robotic technique is a single port entry. Only one very small vertical incision above your belly button not your typical three or four incisions. In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare what’s called the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in. He stated that this keeps the bladder anatomy more intact and in it’s natural place.

 

He explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.

 

He also while I was under anesthesia sent my initial tissues immediately to Pathology to get an immediate staining for positive or negative margins. He was not expecting anything as the PET scan had indicated everything was in the capsule and from his experience did not see anything suspicious in the outlying tissue, however although the lymph nodes came back negative, there was positive margin, having just left the capsule. He then had to go back in and spent additional two hours trying to cut what he could to eliminate the positive margin. At that point I needed then to wait two weeks until I saw him and he said the final pathology report showed negative margins.

 

I know when people are considering Surgery, and questioning surgeons in consultation in addition to inquiring about nerve sparing, ask about single port, Puboprostatic ligament sparing and Retzius sparing and where they may be currently done.

 


Sent from my iPhone

User
Posted 09 Oct 2024 at 00:35
I want to share my recent prostatectomy surgery. We all hear about having nerve sparing surgery but their are now even more advancements in the surgery.

 

I was dry with no leaking immediately after the catheter was removed. The latest DaVinci Robotic technique is a single port entry. Only one very small vertical incision above your belly button not your typical three or four incisions. In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare what’s called the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in. He stated that this keeps the bladder anatomy more intact and in it’s natural place.

 

He explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.

 

He also while I was under anesthesia sent my initial tissues immediately to Pathology to get an immediate staining for positive or negative margins. He was not expecting anything as the PET scan had indicated everything was in the capsule and from his experience did not see anything suspicious in the outlying tissue, however although the lymph nodes came back negative, there was positive margin, having just left the capsule. He then had to go back in and spent additional two hours trying to cut what he could to eliminate the positive margin. At that point I needed then to wait two weeks until I saw him and he said the final pathology report showed negative margins.

 

I know when people are considering Surgery, and questioning surgeons in consultation in addition to inquiring about nerve sparing, ask about single port, Puboprostatic ligament sparing and Retzius sparing and where they may be currently done.

 


Sent from my iPhone

User
Posted 09 Oct 2024 at 07:25

Gosh how technology and practices advance. I believe that they have now introduced this in Liverpool recently and did the 1st operations using it a couple of weeks ago. Possibly the 1st NHS hospital to use it? 

User
Posted 09 Oct 2024 at 08:54

Originally Posted by: Online Community Member
As for penile length, I definitely lost an inch


Me too, and 50% is a lot to lose. 😁


.

User
Posted 09 Oct 2024 at 21:52

Great write up Ned.


I had neuroSAFE too along with retzius sparing RARP conducted by the prof at guys (London) and his sidekick DaVinci Xi (Nov 2019). The SP system looks very cool.


i didn’t appear to lose any length…almost immediately when i got back to my room after surgery I was measuring up from the previous nights data point. Had to be creative with the explanation when the nurse walked in and I was surveying my chap πŸ€ͺ🫒


Best of luck with the recovery process and long may the PSA bloods come back favourably.


cheers


simon

Edited by member 09 Oct 2024 at 21:58  | Reason: Not specified

User
Posted 26 Oct 2024 at 06:27
Thanks for this. I have been waiting to get a treatment plan. I had my MRI done in May and waited until August for the biopsy. I did see a surgeon and radiation oncologist this week. I have a second opinion with a surgeon in the same hospital system in a few weeks. My biggest concern with surgery is urinary incontinence. However, radiation can have the same outcome and also can cause bowel incontinence. Regarding the one-port procedure: were you leaning back with your head towards the floor? That is what the surgeon told me they would do, although it may be an issue because of my weight (287 lbs or about 20 stones.) I'm in the US. Even though we have a wonderful cancer center near me, I can't find one close by that offers this type of surgery, only robotic. It seems the nearest center is in New York City. I'll have to ask my surgeon if they do this procedure here.
User
Posted 26 Oct 2024 at 18:24

JPR,


My Surgeon told me the surgery was conducted with me flat on my back. When he described it as my being upside down he was just explaining how he was operating on me from his visually robotic arms. He came from above my belly button approaching the prostate from above and my single incision is above the belly button and would be above the bladder and prostate. The surgery is using DaVinci’s latest robotic’s. A big concern of mine certainly along with ED was the incontinence, which I avoided. I have no idea if this surgery is dependent on the size at all of a person’s actual prostate, mine was considered small.

User
Posted 28 Oct 2024 at 08:40

Hi Ned,


Thanks for the post. Wish I'd had the new technique you detail as the incontinence is driving me mad, to the point where I am forcing myself to go out, it's just too much hassle.


To be honest I'm not sure what I expected but this aint it 🀣


I was prepared for the not getting to the toilet quick enough resulting in a leak, but having a leak/dribble when there is no indication that I even needed the toilet has really shocked me.


Good luck with the rest of your recovery.

Dave

User
Posted 09 Nov 2024 at 15:17

Kevan,


it was a hospital in California. I know this is primarily a UK site, so it might not be practical, but if still interested I will let you know.

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User
Posted 09 Oct 2024 at 07:25

Hi,


Thanks for posting this, I found it a very interesting read. It's fascinating how techniques evolve and improve over time. 


I had my nerve sparing surgery almost five years ago and my six scars are barely visible now. As for penile length, I definitely lost an inch which is more noticeable when flaccid. My wife reassures me that it's a more comfortable fit when erect.


Good luck with your recovery. 


Kev.

User
Posted 09 Oct 2024 at 07:25

Gosh how technology and practices advance. I believe that they have now introduced this in Liverpool recently and did the 1st operations using it a couple of weeks ago. Possibly the 1st NHS hospital to use it? 

User
Posted 09 Oct 2024 at 08:33

Fascinating review and for all those with a surgery option I hope this technique becomes the normal….the guys in my Maggies Prostat Support Group love showing off their scars so I’ll have less to look at🀣🀣🀣


Good luck with your recovery and will be very interesting to see how it progresses.


Derek

User
Posted 09 Oct 2024 at 08:54

Originally Posted by: Online Community Member
As for penile length, I definitely lost an inch


Me too, and 50% is a lot to lose. 😁


.

User
Posted 09 Oct 2024 at 14:38

Kev,


Happy to hear things are so well after five years. I am also amazed in cancer medical treatments overall where they have come. All the clinical trials that have led to such improvements. I certainly have benefited.


I am very happy to have the same length now and I am to wait and see about getting rid of the ED. The night of Surgery I was sent home, never even spent one night in the hospital. The Surgeon that night started me on sildenfil (viagra) a very low dose. He said that was to keep blood activity although you won’t know it. He said regardless of nerve sparing there is trauma to the nerves that take time for those to regenerate and heal. I can tell now I am having some more feelings in the mornings and he appears wanting to wake up as getting more girth in the mornings. I get my first PSA in two weeks and see my Surgeon where he bumps up my dose of sildenfil. He is totally optimistic but says you want to go slow to let everything heal.


 

User
Posted 09 Oct 2024 at 14:47

MGOR, 


Hopefully more hospitals will, it takes probably more younger surgeons that want to stay up to date on their Surgical techniques. I know surgeons that have done things certain ways and are good at it, as we all know it takes hundreds of operations in a technique to get really good at it. They probably just don’t want to start over.

User
Posted 09 Oct 2024 at 14:48

Derek,


I am definitely happy with my small scar snd hope for many years I can also show it off.

User
Posted 09 Oct 2024 at 14:52

That was a big concern that I did have and I am happy. 

User
Posted 09 Oct 2024 at 17:04

If you're starting to get feelings in the morning, I think that's a good sign and how it started for me, it took me quite a while so try not to be disheartened if it seems to take a long time. 


Kev.

User
Posted 09 Oct 2024 at 21:52

Great write up Ned.


I had neuroSAFE too along with retzius sparing RARP conducted by the prof at guys (London) and his sidekick DaVinci Xi (Nov 2019). The SP system looks very cool.


i didn’t appear to lose any length…almost immediately when i got back to my room after surgery I was measuring up from the previous nights data point. Had to be creative with the explanation when the nurse walked in and I was surveying my chap πŸ€ͺ🫒


Best of luck with the recovery process and long may the PSA bloods come back favourably.


cheers


simon

Edited by member 09 Oct 2024 at 21:58  | Reason: Not specified

User
Posted 09 Oct 2024 at 22:49

Simon,


It’s interesting how none of us want to lose any length and at times that seems more of a side effect concern than incontinence and you can understand. The Surgeons and technology only continue to get better and it just has become more and more important that patients are aware of the latest technology and surgical techniques to inquire with their Doctors and if their Doctors are not to date to be willing to seek additional consultation.

User
Posted 09 Oct 2024 at 23:11

Totally. For me not having neurosafe would be like flying blind. The real-time pathology during surgery came back suspect so the surgeon was able to take more tissue there and then. 


Great to see all the new tech for sure.

User
Posted 26 Oct 2024 at 06:27
Thanks for this. I have been waiting to get a treatment plan. I had my MRI done in May and waited until August for the biopsy. I did see a surgeon and radiation oncologist this week. I have a second opinion with a surgeon in the same hospital system in a few weeks. My biggest concern with surgery is urinary incontinence. However, radiation can have the same outcome and also can cause bowel incontinence. Regarding the one-port procedure: were you leaning back with your head towards the floor? That is what the surgeon told me they would do, although it may be an issue because of my weight (287 lbs or about 20 stones.) I'm in the US. Even though we have a wonderful cancer center near me, I can't find one close by that offers this type of surgery, only robotic. It seems the nearest center is in New York City. I'll have to ask my surgeon if they do this procedure here.
User
Posted 26 Oct 2024 at 06:27
Thanks for this. I have been waiting to get a treatment plan. I had my MRI done in May and waited until August for the biopsy. I did see a surgeon and radiation oncologist this week. I have a second opinion with a surgeon in the same hospital system in a few weeks. My biggest concern with surgery is urinary incontinence. However, radiation can have the same outcome and also can cause bowel incontinence. Regarding the one-port procedure: were you leaning back with your head towards the floor? That is what the surgeon told me they would do, although it may be an issue because of my weight (287 lbs or about 20 stones.) I'm in the US. Even though we have a wonderful cancer center near me, I can't find one close by that offers this type of surgery, only robotic. It seems the nearest center is in New York City. I'll have to ask my surgeon if they do this procedure here.
User
Posted 26 Oct 2024 at 07:32

I found the key to minimising risk in terms of urinary incontinence was to find a highly experienced pioneering surgeon with excellent high volume (> 100 procedures a year) outcome data. Urinary incontinence was a concern for me but in my head being potentially cancer free was my higher priority. I was fully continent at 5 weeks once the stitches started to soften and haven’t looked back since. Occasionally get a couple of drips if i let my bladder get too full but it’s very predictable so totally manageable. I’m also in the gym weight training a lot and never have issues as I tend to empty my bladder before it’s full to avoid leaks. I wouldn’t worry too much if you have an excellent surgeon as I went through the same dilemmas and afterwards realised that it was all unnecessary with cancer removal being the priority and everything else can be managed as and when they present as an issues. 


Specifically I had retzius sparing RARP with neurosafe. The data basically shows the approach generally gives faster continence recovery than other approaches but after a year tends to converge with other approaches in terms of continence. Key factor seems to be just to find a highly skilled technical surgeon which hopefully stacks the cards on your side for successful outcome.


In terms of angle when on the operating I believe with robotic surgery the patient can be tilted back which apparently increases load on the heart but this would all be fed into the mix I guess when assessing your suitability and pre-op screening where I went for detailed heart tests. 


leading up to surgery my BMI was ~29. When I went in on the day I had got it down to ~24 with gym and avoiding alcohol etc My surgeon mentioned around ~25 is optimum for surgery but not to be too concerned. These are mostly details the surgical team will be very experienced with so I wouldn’t  tend to overly worry about it. 

User
Posted 26 Oct 2024 at 18:24

JPR,


My Surgeon told me the surgery was conducted with me flat on my back. When he described it as my being upside down he was just explaining how he was operating on me from his visually robotic arms. He came from above my belly button approaching the prostate from above and my single incision is above the belly button and would be above the bladder and prostate. The surgery is using DaVinci’s latest robotic’s. A big concern of mine certainly along with ED was the incontinence, which I avoided. I have no idea if this surgery is dependent on the size at all of a person’s actual prostate, mine was considered small.

User
Posted 28 Oct 2024 at 08:40

Hi Ned,


Thanks for the post. Wish I'd had the new technique you detail as the incontinence is driving me mad, to the point where I am forcing myself to go out, it's just too much hassle.


To be honest I'm not sure what I expected but this aint it 🀣


I was prepared for the not getting to the toilet quick enough resulting in a leak, but having a leak/dribble when there is no indication that I even needed the toilet has really shocked me.


Good luck with the rest of your recovery.

Dave

User
Posted 28 Oct 2024 at 15:08

Dave,


Thank you. Keep optimistic. A lot of people on the board share how it just takes sometimes a lot of time to regain control of continence and work diligently on their Kegel exercises. I understand I may be in a fortunate group in regaining continence immediately. I read how some have little ED issues afterwards where in that category it looks like it may take me some time. 

User
Posted 08 Nov 2024 at 04:45

Hi Ned


Most interesting to hear about this new technique, particularly as I’m in the process of arranging surgery.


If it’s okay could you please tell me who the surgeon and hospital was?


Thanks Kevan

User
Posted 08 Nov 2024 at 04:55

Tanks MGOR for sharing the info that Liverpool NHS maybe using this new technique that Ned talked about. If you don’t mind me asking where did you hear about this? Do you have any more information about it?


Thanks


Kevan

User
Posted 09 Nov 2024 at 15:17

Kevan,


it was a hospital in California. I know this is primarily a UK site, so it might not be practical, but if still interested I will let you know.

User
Posted 24 Nov 2024 at 20:25

Originally Posted by: Online Community Member
as the incontinence is driving me mad,


Hi Dave,


I'm with you!


I had extremely bad luck with my RP in terms of bladder control:
For many week I needed 8-10 diapers per day and no (real) improvement although I did my exercises very stricly.


After 7 weeks I wanted to do something about it and odered an "EMS training unit". 250 € (= approx 250 US$).


I used it every day for three sessions per day, 30 minutes each, not missing a single training.


After approx. 2 week very small improvements showed up, and from there it improved step by step - and after 3 months of treatment I'm fully continent now.


If you consider EMS:


+ Forget adhesive electrodes, go with an anal electrode from day one


+ Buy a unit where you can configure your own stimulation programs. I needed to increase the strength of the stimulation like Arnie the dumbells in the Gym. Ended up at: 10s active - 10 s pause / 35Hz repetition frequency / 400µs impuls width  / 65mA stimulation current


+ During active stimulation intervalls: Work your urine sphincter - In the beginning it's hard, but you will master it!


+ Insertion depth of the anal electrode: In the beginning it's normal to have it in 1-1,5 inches. If you have increasingly better control over your sphincter, get the anal electrode all the way in. It boosts the training very much, but you will need (much) more current


+ Before you ask: Yes, it's totally normal for every man to stick an electrode in the butt and apply electro stimulation - at least in our situation


+ If you need more information, you are more than welcome to send me a personal message. I'm happy to help.


I got rid of truely horrible incontinence, and I'm pretty sure this works for others as well!


Very dry regards,


Henrik

User
Posted 24 Nov 2024 at 23:16

Originally Posted by: Online Community Member


After 7 weeks I wanted to do something about it and odered an "EMS training unit". 250 € (= approx 250 US$).



I think I remember some posts from a member called Steve86 https://community.prostatecanceruk.org/default.aspx?g=profile&u=52221


who had his RP in France. I think his EMS treatment was carried out at the hospital by outpatient visits.

Edited by member 24 Nov 2024 at 23:37  | Reason: Not specified

Dave

 
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