Posted , 6 users are following.
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"?
2 likes, 22 replies
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gene97713 DDD1983
Posted
Here is the description of Simple Prostatectomy by Mayo clinic:
Although simple prostatectomy works well at relieving urinary symptoms, it has a higher risk of complications and a longer recovery time than other enlarged prostate procedures such as transurethral resection of the prostate (TURP), laser PVP surgery or holmium laser prostate surgery (HoLEP).
Risks of open simple prostatectomy include:
Bleeding
Injury to adjacent structures
Urinary incontinence
Dry orgasm
Erectile dysfunction (impotence)
Narrowing (stricture) of the urethra or bladder neck
How you prepare
Before surgery, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). Cystoscopy lets your doctor check the size of your prostate and examine your urinary system. Your doctor may also want to perform other tests, such as blood tests or tests to specifically measure your prostate and to measure urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to discuss with your doctor:
Food and medications
Your medications. Tell your doctor about any prescription or over-the-counter medications or supplements you take. This is especially important if you take blood-thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others). Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days before the surgery.
Medication allergies or reactions. Also talk to your care team about any allergies or reactions you have had to medications.
Fasting before surgery. Your doctor will likely ask that you not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
Bowel prep before surgery. Your surgeon may ask you to do an enema prior to surgery. You may be given a kit and instructions for giving yourself an enema to clear your bowels the morning of surgery.
Clothing and personal items
Your treatment team may recommend that you bring several items to the hospital including:
A list of your medications
Eyeglasses, hearing aids or dentures
Personal care items, such as a brush, comb, shaving equipment and toothbrush
Loosefitting, comfortable clothing
A copy of your advance directive
Items that may help you relax, such as portable music players or books
Plan ahead to avoid wearing these items into surgery:
Jewelry
Eyeglasses
Contact lenses
Dentures
Arrangements after surgery. Ask your doctor how long to expect you'll be in the hospital. You'll want to arrange in advance for a ride home, because you won't be able to drive immediately following surgery.
Activity restrictions. You may not be able to work or do strenuous activity for several weeks after surgery. Ask your doctor how much recovery time you may need.
What you can expect
Before the procedure
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any pain, although spinal anesthetic is rarely used anymore. In some instances, intrathecal injections are also provided in addition to general anesthetic.
Your doctor may also give you an antibiotic right before surgery to help prevent infection.
During the procedure
Incisions for open and robotic prostatectomy
Incisions for open and robotic prostatectomy
The incision for an open prostatectomy (left) is longer than the small incisions for robotic surgery (right).
Robot-assisted radical prostatectomy. Your surgeon sits at a remote control console a short distance from you and the operating table and precisely controls the motion of the surgical instruments using two hand-and-finger control devices. The console displays a magnified, 3-D view of the surgical area that enables the surgeon to visualize the procedure in much greater detail than in traditional laparoscopic surgery. The robotic system allows smaller and more-precise incisions, which for some men promotes faster recovery than traditional open surgery does. Just as with open retropubic surgery, the robotic approach enables nerve-sparing techniques that may preserve both sexual potency and continence in the appropriately selected person.
You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.
Standard retropubic radical prostatectomy. Your surgeon makes an incision in your lower abdomen, from below your navel to just above your pubic bone. After carefully dissecting the prostate gland from surrounding nerves and blood vessels, the surgeon removes the prostate along with nearby tissue. The incision is then closed with sutures. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage, which can lead to problems with bladder control and erections.
Simple prostatectomy. Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cystoscope) is inserted through the tip of your penis to see inside the urethra, bladder and prostate area.
Your doctor will then insert a tube (Foley catheter) into the tip of your penis that extends into your bladder. The tube drains urine during the procedure. Your doctor will make a cut (incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision through the bladder to reach the prostate.
If you also have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.
Once your doctor has removed the part of your prostate causing symptoms, one to two temporary drain tubes may be inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder (suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the procedure
After surgery you should expect that:
You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the IV is removed.
Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet while you're in bed.
You'll likely go home the day after surgery. When your doctor thinks it's safe for you to go home, the pelvic drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.
You'll return home with a catheter in place. Most men need a urinary catheter for five to 10 days after surgery.
Make sure you understand the post-surgery steps you need to take, and any restrictions.
You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six weeks.
You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it's OK.
You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about six weeks and then again after a few months. If you have problems, you may need to see your doctor sooner or more often, although it's unlikely.
You'll probably be able to resume sexual activity after recuperating from surgery. After simple prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen.
Results
Robot-assisted prostatectomy can result in reduced pain and blood loss, reduced tissue trauma, a shorter hospital stay, and a quicker recovery period than a traditional prostatectomy. You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.
Open simple prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most invasive procedure to treat an enlarged prostate, serious complications are rare. Most men who have the procedure generally don't need any follow-up treatment for their BPH.
gene97713 DDD1983
Posted
Congratulations DDD,
Another proof that median lobe is not a predicament for PAE. It's the IR. Was it covered by insurance?
That size of prostate will most likely grow back within 2 years. Second PAE are usually less effective. Let's keep our fingers crossed.
It was too fast... YOu will see further improvements, sometimes up to 12 months after PAE.
All the best. Gene
TNVA gene97713
Posted
Gene
DDD is seeking names of ejaculation preserving simple Prostatectomy surgeons.
I had the PAE by Dr B in December of 2019. Covered by Medicare. Dr B brought PAE to the USA and did the trials to have PAE approved by FDA, Medicare and many insurance companies. He has well over 1000 PAE procedures to his credit and he is an innovator still.
Had some pain on the evening of the procedure that could have been avoided had I followed the doctor's medication protocol more closely. Other than that I am amazed at the results.
The best treatment for a specific patient can only be the result of having more than adequate information about that patient's prostate and symptoms. Making broad brush statements about a particular procedure or set of symptoms is foolish, as is taking one specialist's opinion. I have yet to find anybody who knows everything about anything.
Gathering that information may require visiting several medical specialties. You may need a CT Scan or MRI and Urodynamic testing. Researching possibilities on this forum and consulting with many specialties will provide information to make a decision as to the best treatment for a particular patient.
gene97713 TNVA
Posted
I might misconstrued who had PAE on December 19 and directed my response to DDD.I had my PAE 22 month ago, and while observe some fading, my urinary and sexual functions rolled 15 years back by now. I will probably need something in the future. It might be another PAE or some new technique developed by then. Maybe I will get away with what I have now. I agree with you that broad brushed statements are not good in medicine. Nevertheless my IR operator on PAE, currently a Professor at Stanford told me that he doesn't care about the size of the median lobe and in case like mine, when artery are free of aterosclerotic plaque and normal anatomy, the results are 90% guaranteed. Of course it was a very special CT scan with contrast that he used as a roadmap for advanced PAE technique. Don't see the need of Urodynamic test though as it tests mostly bladder functions. PAE can do nothing for the bladder. YOu don't need to go to a few professionals once you have settled your mind on PAE. You IR operator will order special CT scan and most likely TRUS imaging for prostate size and anatomy. Ultrasound has better resolution than CT scan of prostate.
I'm much ahead of you in terms of the PAE and can tell you what will happen next, albeit everybody is different. I have experienced excruciating pains two weeks after PAE and then things started slowly to improve. I had the same feelings of traveling back in time.
Unfortunately capillary grow back and dihydrotestosterone with blood comes back to prostate an stimulates growth. Second PAE according to publications is much less effective than first.
Best of luck.
TNVA DDD1983
Posted
Gene
I suggest seeking information from multiple people (doctors included) and sources because i see too many people led down the path by a doctor who may have limited knowledge or other reasons to steer the patient in a direction that may not be the best solution for that person.
Good decisions require good information.
My problems started with Post Operative Urinary Retention (POUR) from a non urinary related surgery. Full retention and late night ER trip then to uro who neglected my care.
Infection and five different antibiotics finally subdued the infection after more than a year. A PICC line in my arm and 20 days of Ceftriaxone (rocephine) knocked it out. infectious disease specialist finally ordered a CT scan concerned there might be an abscess and we finally discovered the very large prostate.
So an uncaring uro and an Infectious Disease doc made a lot of money on the case and I lost a lot of time. Simple inexpensive CT Scan at the outset would have been much more economical and effective. Ultasound may have been cheaper with no radiation.
The process did give me time to research BPH and treatments. Thank God
Do not wonder why USA healthcare costs so much. Greed and Ignorance