Ejaculation preserving techniques with a Simple Prostatectomy

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We have read multiple articles about ejaculation preserving techniques used during Simple Prostatectomies. I SIMPLY can't find any doctors that actually use these techniques. Does

anyone in the world - as in the whole world - know of anyone surgeon practicing this "simple

procedure"?

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  • Posted

    Much depends on your median lobe as it is the bladder neck area where damage can be done.

    I was fortunate in each of my two procedures (UK) that my lateral lobes were the main problem and British surgeons are evidently more conscious in preserving that area.

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  • Posted

    Prostatectomy in Latin move removal of prostate. It's removed from a capsule as avocado tissue is removed from it skin. It can preserve erection but not ejaculation ducts.

    RE is inevitable.

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  • Posted

    My research (limited) was similar with one possible exception - DaveCanPee.

    Dave posted on several threads here and is very pleased with the outcome of his SP. I am not 100% certain but Dave says his urethra, ducts and nerves were spared. No RE

    Surgeon was in Oklahoma. Let me know if you need help finding his posts.

    My opinion after reading here, YouTube and talking to an experienced surgeon and his Resident is that many are trained to destroy the urethra as part of the surgery and do not know any other way. Many docs take the expedient and Standard Practice route. Patient suffers, who cares. Many never think beyond their training.

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    • Posted

      TNVA,

      I'm afraid you are confusing TURP with Simple Prostatectomy. Any Prostatectome removes all the mass of the prostate and can spare the seminal ducts and other important elements of the ejaculation tract. Even the outer bladder sphincter can't be spared.

      Any preserving operation can be performed only in partial prostate surgeries.

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    • Posted

      Gene

      "I'm afraid you are confusing TURP with Simple Prostatectomy."

      If you are referring to my comments about Dave's surgery please read his posts and ask for him to send evidence of his Simple Prostatectomy. Dave has a picture of the portion of his prostate gland that was surgically removed, in one piece. It clearly indicates the surgeon carved around the urethra with great precision. Dave has full and complete urinary and sexual functions. No incontinence, no ED, no RE. Dave refers to his procedure as a Simple Robotic Prostatectomy.

      If you are arguing definitions, my apologies but that does seem to be the issue in the confusion of just what a "Simple Prostatectomy" is. Some doctors run a laser up the urethra and destroy the urethra and surrounding prostate tissue and tell their patient they had a Simple Prostatectomy. Much different than Dave's SP.

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    • Posted

      I've never heard of the urethra being destroyed after any TURP, LASER or other procedure. The urethra suffers some trauma and swelling but soon recovers.

      You said: Some doctors run a laser up the urethra and destroy the urethra and surrounding prostate tissue and tell their patient they had a Simple Prostatectomy"

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    • Posted

      Of course it's frequently destroyed inside the prostate. It's very difficult to preserve it during the TURP. How are the pieces of prostate removed during TURP which is done (as well as any Laser surgery) through the the urethra? Do you understand the anatomy of the prostate. On the other hand, I should take back my words regarding the ejaculation preservation. A paper circa 2019 appeared, that discusses the preservation of ejaculatory function during the robotic simple prostatectomy. Probably the precision of the robotic surgery allows that operation.

      You can research it online:

      Urethra and Ejaculation Preserving Robot-assisted Simple Prostatectomy: Near-infrared Fluorescence Imaging-guided Madigan Technique.

      In "European Urology". Hopefully will happen in US eventually It was performed in Rome, Italy and uses a special technique to guide the surgeon. It's totally novel.

      Can't be done blindly.

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    • Posted

      Derek,

      How can a surgeon to take out prostate through urethra without destroying the intra -prostate urethra? Check the supplied anatomy picture.

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    • Posted

      Look up a You Tube entitled "Robotic Simple Prostatectomy" by J D Engel,MD and see what a common practice does to the urethra as part of a Simple Prostatectomy. He mentions the possible difficulty of getting a catheter into the bladder after the procedure - because he cut the urethra after clearly identifying it. Several You Tube videos are available showing SP's.

      My interest and the original post by DDD1983 is in finding surgeons who spare the urethra and other anatomical items necessary for normal urinary and sexual function.

      I recall reading one report on a SP using a dye to help identify the urethra so as to spare it. This must be the "Madigan Technique". Report closed with a comment that this method was not accepted by most surgeons.

      Dave provided a picture of the very large portion of his prostate that was surgically removed with extreme precision by a caring and very skilled expert. The removed portion clearly shows how the surgeon carved around the urethra. I can attempt to PM the picture if it will work and if Dave has no objections.

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    • Posted

      derek

      I was referring to the portion of the urethra that transits the prostate. The bladder sits on the prostate and the urethra comes out of the bladder at the bladder neck, if you will, through the involuntary bladder sphincter. Damage the sphincter and you increase odds of complications - Incontinence, ED, but more so Retrograde Ejaculation . Nerves have more to do with ED and the lower (prostate) sphincter may control incontinence.

      There is another sphincter a the base of the prostate - this one is voluntary, it's how you release when you urinate. The bladder sphincter is triggered when the bladder is "full" messaging you to release the lower sphincter soon. Injury, infections, irritable bladder can interfere with this system.

      Some BPH treatments go up the urethra and with very small "needles" go through the urethra wall to destroy prostate tissue - Rezum (steam) and Aquablation (high pressure water) but some TURP and laser treatments just start at the urethra and cut away. The area fills in with scar tissue.

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    • Posted

      Yes, it can be done but not without special visualization technique that use fluorescent dyes. It's definitely experimental and used only by a very few surgeons. Can't imagine how it was done in Dave's case without special imaging. Also, the presence of the median lobe makes it practically impossible according to th e recent paper from Rome hospital

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    • Posted

      Simple prostate removal is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. It is done through a surgical cut in your lower belly.

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    • Posted

      Can you please let me know who the surgeon was in Oklahoma.

      I am finding several articles written about ejaculation preserving techniques that

      are beginning to be talked about. It seems that doctors in general don't prefer change

      until they are the patient.

      Dr. Steve Kaplan wrote an article about this in the American Urological Journal. I'd really

      like to get a hold of him.

      Anyone know him?

      Dana

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    • Posted

      DDD

      Just PM'd the surgeon's contact info.

      "It seems that doctors in general don't prefer change until they are the patient."

      Brilliant observation.

      I fired a "Bell Curve Bob" type urologist. Statistics only matter to me if they are effective for my situation. He never did any diagnostics - just started throwing drugs at me. FloMax and then Finesteride. The latter would have done nothing but risk my health. The prostate was way too large and he had No clue.

      Thanks for the news of the journal article. Please let me know if you learn of any caring surgeons.

      I went with PAE on December 19, 2019 with Dr B, Woodbridge, VA. 200 ML prostate with very large median lobe. All is well now and feel like my anatomical clock has been turned back 30 years.

      I would do the PAE again should the prostate grow back but I would consider a Simple Prostatectomy by a concerned surgeon (like Dave's) depending on my health and circumstances then.

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    • Posted

      I took Dave's post to heart with my 220g prostrate in July last year. My satisfaction is like his, minimal pain, fast recovery, no incontinence, and no RE.

      Please be aware what we had is a Simple Robotic Prostatectomy. A Simple Prostatectomy is not the same thing, it is performed by hand with a large incision and the surgery is done blind for the most part. I talked to an Urologist that wanted to do the Simple Prostatectomy and he admitted that a percentage of patients came away with lifetime incontinence and other possible damage to nerves. Watch the YouTube SRP film clips.

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    • Posted

      Glad to hear of another successful SP/SRP. I am well aware of the distinction, R is for Robotic.

      Can you please provide the name and location of the surgeon. I am compiling a list of surgeons that spare the nerves, urethra, bladder neck and etc. They seem to be hard to find.

      I have watched a few You Tubes of the procedure and not seen one done in the way Dave's was. That is, saving the urethra. More than likely resulting in RE.

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