Robotic Surgery Blog: Treatment side effects Archives

April 26, 2008

Long-Term Functional and Oncological Outcomes of Patients Undergoing Sural Nerve Interposition Grafting during dvP

Despite optimism regarding SNG, long-term functional outcomes have been disappointing, particularly for BL nerve interposition. UL-SNG functional outcomes do not appear to improve outcomes when compared with men with UL nerve preservation. With the greater risk of PSM and BCR in patients who are considered candidates for SNG, newer treatment modalities are needed to cure their disease while preserving SF.

My friend Dr. Shalhav and his team at Chicago haver reported on their results for nerve grafting in men whose nerves are removed for better cancer control.

This study has been consistent with most studies that have not shown a benefit.

The main problem with the neurovascualr bundle is that it is not a nerve, but a fine complex of micro-nerves. It never made sense to me how one nerve would replace these and re-connect the nerves that are cut.

Possibly in the future we can have tissue that can build new nerves on it. I have not been performing these nerve grafts.

October 28, 2007

Sex After Robotic Prostatectomy: Penile Rehabilitation

I have previously written about sexual function and how it changes after prostate cancer surgery.
As men are being diagnosed with prostate cancer at a younger age and at an earlier stage, the preservation of erectile function and the ability to maintain satisfactory erections has become more important. My partners and I offer a variety of options to assist in the recovery of erections including having a vacuum device specialist come in to the office once a month, teaching patients how to give penile injections and intra-urethral suppositories, and prescribing viagra, levitra, and cialis on a maintenance, preventative basis.

One of the most frustrating things is insurance companies not paying for maintenance medicines even though most urologists feel these medicines help erections return sooner and possibly more fully. There was an excellent review of the literature by Dr. McCullough of NYU that I read this weekend. He is one of the world's authorities on erectile dysfunction.

This is a great source of information for urologists who can receive 1.5 CME credits.

I will start giving this link out to patients with a letter to see if it helps get them at least partial payment from insurance companies.

I hope patients report any positive experiences with insurance companies paying for their PDE5 inhibitors after surgery.

I have been personally prescribing 1/2 of a pill of the maximum strength to be taken on Mon, Wed, and Friday evenings.

March 18, 2007

Robotic Prosatectomy at the NCCN

Genengnews.com: Robot Spurs Men's Recovery After Surgery, Urologist Says at NCCN Annual Conference

Even surgeons who once favored traditional 'open' methods of cutting and suturing during prostate or bladder-cancer operations have learned to love the joystick-operated robot, said Timothy G. Wilson, M.D., director of the Prostate Cancer Program at City of Hope Cancer Center, at the National Comprehensive Cancer Network's 12th Annual Conference, March 14-18.
Studies show that men undergoing radical prostatectomy go home sooner and regain bladder control and sexual function weeks earlier when the robot is employed, Wilson said.
'If you can save somebody three months of diaper time, that's important,' he said, noting that patients' two top postoperative worries are incontinence and impotence. Wilson predicted Food and Drug go-ahead for other manufacturers' robotic devices in the next few years, bringing competition to a field now dominated by Intuitive Surgical's da Vinci device, approved in 2000 to perform advanced surgical techniques.

March 17, 2007

Obese patients at higher risk during surgery

Straightfromthedoc: Risk of Post-Operative Complications, Higher in Obese Patients:

Morbidly obese patients had a death rate nearly twice as high as that of all other patients, had higher rate of cardiac arrest and have significantly higher risk of complications following surgery, including heart attack, wound infection, nerve injury and urinary tract infection.
Such were the findings of a new study of a research team at the University of Michigan Health System.

Bamgbade and the other researchers found much higher rates of the following complications in obese patients: heart attack, with obese patients experiencing five times the rate of attack than non-obese patients (0.5 percent versus 0.1 percent); wound infection, with a 1.7-times higher rate (6 percent versus 3.5 percent); peripheral nerve injury, with a four-times higher rate (0.4 percent versus 0.1 percent); and urinary tract infection, with a 1.5-times higher rate (3.9 percent versus 2.6 percent).

This is another study that confirms that obese patients are at increased risk during surgery. I think minimally invasive and robotic surgery has the greatest benefit on obese patients.

January 11, 2007

Radiation and hormonal therapy may lead to penile shortening.

Prostate cancer treatment may shorten penis - Yahoo! News

NEW YORK (Reuters Health) - Men who receive combination treatment with hormone therapy plus radiation for local or locally advanced prostate cancer may experience a significant reduction in penile length, according to a report in the January issue of the Journal of Urology

It has been long suspected that men may develop penile shortening after surgery, but this is the first report that I am aware of that it can also happen after radiation.

December 31, 2006

Urinary side effects after brachytherapy

UroToday - The Pathophysiology of Lower Urinary Tract Symptoms After Brachytherapy for Prostate Cancer

""BERKELEY, CA (UroToday.com) - Lower urinary tract symptoms (LUTS) following brachytherapy are usually considered to subside within a few months of treatment.
However, a subset of patients experience persistent LUTS and Dr. Jerry Blavias and associates from Cornell University characterize this group of patients in a report in the BJU International. ""

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Prostate cancer site by AstraZeneca

There is a decent website from a pharmaceutical company: prostateinfo.com.

It does a decent job of going over the basics involved in screening and explaining the treatment options.

My one big criticism is that is out of date when it comes to robotic surgery and how accepted it is, making up about 30-35% of all radical prostatectomies currently.

I would add HIFU as an experimental therapy and make laparoscopic and robotic procedures an accepted form. I know that there are more robotic prostatectomies done than perineal ones, and pretty sure there are more laparoscopic prostatectomies done in the US than perineal.

August 26, 2006

Side effects of radiation for prostate cancer

Out of the group of 510 patients, who responded to the side effect section, 299 patients (59%) stated that there had been side effects and 211 patients (41%) stated that none had occurred. The following side effects were mentioned: leakage (17%), alguria (14%), diarrhoea (13%), voiding dysfunctions with residual urine (12%), proctitis (10%),urinary incontinence (6%), urethral stricture (5%), cystitis (3%), anal incontinence (3%), evolution of fistulas (1%), retention (1%). 123 patients made a reply on their degree of potency. In total 123 patients reported erectile dysfunction (ED); 24 (8% out of 299)of these had a preoperatively existing ED prior to BT. 99 patients (33% of 299) reported a newly occurred ED post BT treatment

Source: AUA Abstract 1137- UroToday.com

This abstract was retrospective and only 1/8 of patients commented on erections, but there are obvious side effects with radiation that urologists should discuss with their patients.

July 22, 2006

Does radiation therapy for prostate cancer lead to rectal cancer?

In contrast to a study from the University of Minnesota, there is a Canadian study that concludes that there is not a increased risk of rectal cancer when adjusted for age.

June 18, 2006

Sexual life after prostate removal

This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.

The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination (BPH) and is a leading cause of cancer.

The "nerves" that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.

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