Simple Robotic Prostatectomy

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Hello Everyone,

I am 61 years old and can probably safely assume I have had BPH for at least the last 20 years. However, not any more. About 10-weeks ago I underwent a Simple Robotic Prostatectomy and wish I had done it years ago.

For at least the last 10 years I was told I had a large prostate. Never paid much attention to it because sex was good, peed okay, and nothing much else caused me any concern. My PSA was always high, and my urologist at that time (9-10 yrs ago) always wanted to do a biopsy. Under his care I had two done and each time there was nothing. I finally got tired of having my prostate treated like a pin cushion and stopped seeing the urologist all together.

More back story: While I could pee, I also fought having a bashful bladder. Walking up to the urinal meant taking a deep breath, relaxing, and then letting my pee go. Kind of minimal pushing and a light splash in the water (weak stream). If I had to stand next to another guy, or have a bathroom that was real quiet with other people, I struggled to get started, but once started, no problem. Over the years this got more pronounced, but manageable. Just chocked it up to a large prostate and bashful bladder.

Well this last year I started going through some real urinary retention issues. To make this long story short, I had multiple ER visits, numerous catheters, void tests, attempts to self-catheter (terrible experience), and three different urologists. One urologist did an rectum ultrasound and measured my prostate at 343 grams. Another one did a MRI and measured it at 265 grams. No matter how you look at it, my prostate was on the Top 10 list for being enormous. How I was peeing at all is a mystery to me, but I was until all the urinary retention problems quickly reared their ugly heads.

Finally I got the right urologist and he told me all other approaches for my problem was off the table. No other operative steps, no medications (which I have never taken any, including today), etc. My only option, if I wanted to pee and not live life with a catheter, was to undergo a Simple Robotic Prostatectomy. My urologist said he could make me a garden hose. He said he could hollow out my prostate capsules like an avocado and spare my nerve bundles. All good news to me and I said let's do it because I was hating life on a catheter.

I am now 10-weeks post-op. Had to use a catheter for 2-weeks after the surgery (healing process). At 2-weeks the doctor removed the catheter and performed a small void test-no problem. The real aha moment came 3-hours later after my wife and I finished lunch at a restaurant. I had to pee for the first time. I went into the stall, and no sooner did I pull it out, I was peeing like a race horse. It actually surprised me at how much volume came out so quickly. Doctor was right, I had a garden hose. I walked out of the bathroom with a smile on my face. I could not tell you when I ever peed that well before. No more bashful bladder and no more relaxing and just letting my pee flow out. I am pushing and forcing pee out at record speed and volume. The pushing took my bashfulness away. When I go pee now, I hit the water on purpose because I can make the loudest splashing sound in the bathroom, and I finish faster than anyone else.

I just wanted to share and I am more than willing to share more, if interested, at how I have had no erection problems (sex right after the catheter was removed), my orgasms are good, and prostate fluid still passes, but just a little differently. My life is great now and getting better each day that I continue to heal. I never wish a catheter on any man. If a Simple Robotic Prostatectomy is your only option, all I can say is that it worked great for me.

Dave

P.S. Pathology report on my hollowed out prostate mass was benign. I am very lucky and feel fortunate. My only problem was a prostate that insisted on growing to an enormous size and causing me urinary retention. I have a picture of it removed if you want to see it.

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  • Posted

    Hey Dave so happy that all worked out for you. I think you were one of the lucky one. The results do not sound like a simple Robotic Prostatectomy. More like a Helop where they do the same hollow out the prostate and leave the shell. Glad the sex life is good and are you saying you do not get retro. All that matters is that you are happy. Take care and I hope all continues Ken

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    • Posted

      Hi Kenneth:

      No, I did not have a HoLEP. There was no entry through my penis, nor was my urethra (or urethra neck) cut on in any way. Through the use of robotics, my doctor made six (6) incisions in my abdomen area, along with a wide one right above my belly button to remove the prostate mass in one piece. Through the incisions, my bladder was filleted open and my prostate was accessed through the bladder. Robotic equipment was used to hollow out the prostate in one piece and remove it.

      As for retro, yes this has happened, but no worries. I have precum that flows out my penis during foreplay, but during my orgasms, I have the waves of feeling good, but nothing actually ejaculates out (less messy according to my wife). I have to tell you, my volume before with an enormous prostate did not produce much either, and ever so often, I would have retro with the large prostate. Post sex now, when I am cleaning up, I can squeeze/milk out fluid. None of this concerns me because when the doctor could spare my nerve bundles, I knew I would continue having healthy erections and satisfying sex. My procedure provided this, at least for me. I hope others have had success as well. As I continue to heal, I will watch for changes in all this. It has only been 10-weeks.

      Dave

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    • Posted

      Dave Yes I know that you did not have Holep but it sounds the same when you were explaining it. Because that is what they do but through the penis. My doctor said it is like a orange when you take all of the orange out and leave the skin. Your doctor was very good. That is the main concern to any procedure a good doctor. I still don't know why you have pre cum. You may be getting some from what is left of the prostate. If you see your doctor again Can you please ask if he touched the ejaculatory ducts at all. Because if he did not you may get some after you heal. Glad all is good Take care Ken

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    • Posted

      hello ken,

      hope all is well with u!

      keen observation. indeed, the result looks more like from holep than SRP, but both will give patients RE to their patients.

      all surgeries may produce results that fall in the outlier region. this could be one.

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    • Posted

      Thank you DL I sent Dave a few questions on a PM. It intrigued me. He had a very quick recovery and he is having per cum and there is fluid present. And a very good erection. His doctor did what he told him he was going to do. I wish we had more good out comes like that. Being that the ejaculatory ducts are not touch ( I know the connection of the seminal vessel are destroy with the removal of the prostate ) The pre come may be from what is left of the prostate. Maybe after 3 or 6 month's he may get a small ejaculation. Who know. But I am happy that it worked out for him. I forgot to ask where he had it done and what was the doctors name Take care Ken

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    • Posted

      Good morning DL It's almost 5:30 am can't sleep. Was kinda of excited about Dave SRP until I watch the video of the surgery. ( Dr. Jason Engel ) I watch it 4 or 5 times and can't get it out of my head.........................................

      The way Dave's doctor said that I will core out the prostate and save the nerves. Sounds great. The video I watch they went through the bladder because this man had a large bladder stone........................................

      After getting the stone out he also had a large median lobe which was blocking the bladder neck. They took a needle and put it through the lobe and pulled it into the bladder which brought the whole prostate into the bladder where they cut it out. After that they sew everything up and then put the bladder back together.........

      What I can figure out is when they pulled the prostate into the bladder how did they leave the outer core. And with the doctor bringing the prostate inside would that not bring the ejaculatory ducts to. Being that they are near the base of the prostate...

      I may have to watch that again. I have been looking trying to find out haw it is done and what is taking out but can't find anything about it. And then I thought of you and I know you have done research on many procedures.

      I am hoping you know something. Or maybe when I see my urologist maybe he can tell me.. Have a great day and a good Sunday Ken

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    • Posted

      Very interesting stuff you guys are talking about. I do not know the specific details on how my doctor performed the exact procedure other than what I have shared so far. I can add that I was positioned in the OR practically on my head for the 4-hrs that I was under. I guess this aides in letting gravity move the internal organs out of the way some as he comes in with the robotics.

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    • Posted

      Good morning Dave. That is something that they do not mention when you read about the procedure. Have not been to bed yet. Been trying to read up on the Procedure. I just got done writing a letter in a doctor in Washington DC. Been a doctor for over 25 years. He has been doing SRP and others for years. Also watch a few of his videos on the procedures. I have some question for him. By the way. Where did you have yours done and who was your doctor. Glad all is going good for you Ken

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    • Posted

      hello ken,

      glad to see u are so enthusiastic, sacrificing ur sleep to understand op. i also had watched jason engel's operations on youtube. indeed, SRP is complicated.

      some surgeons cut the prostate and some cut the bladder, not sure how they decide.

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    • Posted

      Hi Ken & DL:

      With all the options that are out there, and all the conditions each of us are experiencing, what if we boiled it down to the procedure that does not touch our bladder neck, our urethra, the outer sides of our prostate, our sphincters, and our nerve bundles? For me, this is what it came down to. If I was able to find the right doctor to preserve these things, while removing my enormous prostate, why should I worry about invasiveness or not?

      I know, post-op and feeling great makes it easy for me to say these things, but this is how we learn from each other. Granted, we are all different, but as males, we all share the same anatomy. I am going to wave the flag that we protect and guard what is precious to us and get rid of what causes us grief and pain.

      Dave

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    • Posted

      Yes it was very interesting but I think I will have to watch it again. I did not see where he start cutting the prostate. You know the shell. Yes it is very complicated. Some move the bladder out of the way to get to the prostate. Take care Ken

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    • Posted

      hi dave,

      these are all important tissues or areas if violated will have consequence.

      i think it is a great idea for a prospective patient to come up with a spreadsheet to evaluate each surgery technique and to check if those key tissues are violated, along with complications, recovery time, cost, durability, pros and cons, objective etc. then it will be clearer to him what is the best option for his situation and objective, as oppose to keeping everything in his head.

      this will be a huge job as it took me sometimes more than a month to understand a specific technique. the difficulty is there are just too many surgical techniques for BPH treatment. but if the patient does not want to put in the time, then he has just one choice , listen to his urologist.

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    • Posted

      DL & Dave. That would be great but not all men like to do stuff like that. They don't take the time to understand it. I was like that. When I was 47 My GP called me and told me I had prostate cancer by PSA was 426. I did not know what that was. the prostate or PSA. She told me that I needed to go see a Urologist. To tell you the truth I did not even know what a Urologist. I thought it was a head doctor. Wrong head. When I went to the office and started to answer the guestions Then I know what kind of doctor. I think it is a little better today. We need to do the pros and cons of the procedure that we are looking into before we pick a procedure. This way we are picking what we feeling is right for us. You have to look at your concerns and what you want from the procedure. It takes time you should never rush into it. Because once it's done it done. God Bless Ken

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  • Posted

    SRP works so well for u, congratulations!

    another option as oppose to SRP is HOLEP, which is a minimum invasive surgery. Literature reports that the largest prostate that had been removed by HOLEP was 800cc.

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  • Posted

    just wondering if retrograde ejaculation is one of the complications of SRP. HoLEP will give its patients RE with about 88% certainty.

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