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