Catheter-free option? Not an endorsement

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DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 688
   Posted 1/5/2009 8:51 PM (GMT -7)   
I was actually searching for something else, and ran across this:
----------------
Catheter-free Recovery
For most men, one of the biggest complaints about prostate surgery is discomfort from the urethral catheter. To address this issue, Dr. Menon has developed a surgical technique that eliminates use of the catheter. Urine is drained instead through a small tube, much like an IV tube, through the abdomen. The response from patients has been truly remarkable. When given the choice, 98 percent of our prostatectomy patients prefer this option. More than 400 men have undergone this procedure at the Vattikuti Urology Institute, giving us the largest patient experience with this technique. Make sure you ask us if this option is right for you.
-----------------

The full text is at http://www.henryfordhealth.org/19085.cfm
As the subject says, this is not an endorsement. I just stumbled across this, and wonder what others think. Maybe some here have tried this. Personally, it's not obvious to me that an abdominal tube is preferable to a catheter. You'd still have to wear a bag of some sort.

[What I was searching for was an objective discussion about open vs robotic surgery. Prompted by some members's cases of surgeons saying that robotic would have failed and they'd have to resort to robotic. The search naturally turns up tons of sites telling you how wonderful robotic is. Perhaps buried in there is a listing of advanages of open surgery. Haven't found it yet.]
DJ

Age 53
PSA 2007 about 2
PSA 2008 4.3
Diagnosed September 2008.
Biopsy: 6 of 12 cores positive
Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter removed on 7th day, replaced on 8th day, removed again 14th day following negative cystogram
pT2c
lymph nodes negative
microscopic margins
next PSA 1/22/08


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/5/2009 10:18 PM (GMT -7)   
I don't fancy the idea -- a tube into the abdomen is even less appealing than a tube into the penis.

For me, the worst part was the inconvenience of tube and bags. Sure Willy got a little uncomfortable sometimes, but a discreet reposition fixed that.

One advantage I can see for those eager beavers who can't wait, is that intercourse is theoretically possible with this method. Presumably it's not possible with a urethral catheter -- but hey, what do I know? :-)
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/6/2009 12:00 AM (GMT -7)   
I'm with Piano. No tube is the best tube, but I like natures tube, it was intended to be there. There are times when surgery is difficult regardless of modality. Dr Menon, has a couple reasons he knows a lot about this. He was the very first robotic laproscopic surgeon. And when you are a pioneer, it's not always like Daniel Boone. I am sure there were lessons in the process. However, his great contributions are ever lasting. But again, regardless of modality, things can go awry. I have seen many cases here and it isn't predictable.

On the other robotic part. In open surgery, a large gash is made for the surgeons access. In robotics, when this surgery is done, tiny holes are made for the arms of the robot and then the abdomen cavity is inflated so that the surgeon can view the field with a laproscopic camera. The advantage for open is that a palpable tumor can be felt by a surgeons hands. The advantage of robotics is two fold ~ He can magnify the field of vision many times with clarity and in locations he can't see otherwise. The second advantage is because the surgery is less invasive there is less blood loss. I don't buy arguments that the procedure doesn't remove enough tissue, but an inexperienced surgeon might. There are real times when a robotic procedure is aborted, and an open procedure completed. Any patient that has had a previous abdominal surgery should ask about this. Because of scarring, prosthetics, and many unknowns, it may be worthwile to fore go the robotic procedure in favor of an experienced open surgeon. It is a matter of having the best guy for you, and this may be something to review. I personally had a great experience with the same doctor as DJ. Dr Wilson took extra care and time when he saw possible extraprostatic extension and he was right. The plumbing worked fine.

Again, the surgeon is more important than the modality. But they can be great robotic, laproscopic, or open...and still have those rare cases where complications happen.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 

Post Edited (TC-LasVegas) : 1/6/2009 12:05:20 AM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/6/2009 4:08 AM (GMT -7)   
I don't claim to know alot about surgery, but did pickup some things along the way. I found out that I was not even a reasonable candidate for successful surgery and so Dr. Menon (Henry Ford Hosp.-Vattuki Center) was straightforward and honest enough to say to me "no way will I operate on you" when I got 1 of many opinions I was questing for. The man is very honest apparently and did not want my excellent insurance money, other surgeons were eager to sign me up for surgery (multiple opinions I did get).

Also, you can correct me Tony or whomever, isn't it in effect 'easier' for the doc to sample lymphnode in the open r.p.-surgery method (old) even though the robotic can do this, it is through small incision and maybe not quite as easy to access for such sampling. If the nodes have cancer many times the surgery is canceled or the patient is informed as to risk and do you want to remove it anyway to remove the 'tumor burden', knowing curative is not the intent. This is what I heard years ago now.

zufus- (get multiple opinions is worthy stuff)
"Youth is wasted on the young"-W.C. Fields
 
"I wouldn't join a club that would have me as a member"-Groucho Marx


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/6/2009 7:28 AM (GMT -7)   
DJ, that's an interesting alternative to the catheter, but sounds to me, more invasive then a standard catheter, and this is coming from the guy that is now on day 53 of having a catheter in place. I don't see the advantage of doing i the other way, and how do they remove the tube from the abdomen when they are through healing? Interesting, though.

David in SC
Age 56, 56 at DX
 
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
 
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
 
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, further tests/treatments 1/9/8.
 
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/6/2009 7:41 AM (GMT -7)   
zufus,
My team had no trouble removing and testing 10 of my lymph nodes and I have heard of testing as many as 22 through robotic. It is actually advantageous in robotic for lymph node dissection ~ so I have heard. That is at least no longer true, though I am not certain how it was when you started out. My understanding is there are no hinderences in robotic except palpable touch. Some say that is not an advantage. I know of open surgeons who do not test lymph nodes unless they see a visual reason to, and surgeons who remove nerves because of PNI. Again the important part is the quality of the surgeon, not the technique. Many surgeons won't abort the procedure even though the nodes are positive...Some including Myers feel that is helpful to procede as there is evidence that HRPC begins often in the prostate.

Tony

Post Edited (TC-LasVegas) : 1/6/2009 7:44:43 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/6/2009 8:54 AM (GMT -7)   
If I did this link correctly, this is a good piece on advantages of open rp
palpable-prostate.blogspot.com/search?q=2007%2F03%2Frp-vs-lrp-vs-rlrp-part-1-open-surgery.html%2B

david in SC

Post Edited By Moderator (James C.) : 1/6/2009 9:50:14 AM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/6/2009 11:00 AM (GMT -7)   
Thanks for info Tony for the sake of others, alot parameters to know about surgery, more than the average person who is informed a bit would know about. The mention about a doc doing open RP and not sampling nodes, I asked a surgeon this at a support group meeting and he said he does not always do this (wow), if you are the patient you might want to ask this prior to your surgery as to "does it get done for sure" and you want to know post op pathology found, compare to biopsies findings could significantly change Partin Tables, Narayan, Bluestein and all the nomograms. Might give you a heads up on what you may have to consider down the road.
 
 
 
 (I was referring to a speaker doc at a meeting, not Dr. Menon-in case anyone thought different)

Post Edited (zufus) : 1/7/2009 9:51:19 AM (GMT-7)


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 688
   Posted 1/6/2009 1:54 PM (GMT -7)   
David, thanks for the interesting link. Looks good.

zufus, prior to my surgery, I had to sign off what the surgeon was going to do. The prepared form said prostatectomy, but the surgeon said we're also going to do a lymph node dissection, so he wrote that in by hand, and had me sign that off as well.
DJ

Age 53
PSA 2007 about 2
PSA 2008 4.3
Diagnosed September 2008.
Biopsy: 6 of 12 cores positive
Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter removed on 7th day, replaced on 8th day, removed again 14th day following negative cystogram
pT2c
lymph nodes negative
microscopic margins
next PSA 1/22/08


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/6/2009 4:31 PM (GMT -7)   
DJ- Hope other newbies get the heads up, look to sign for such and always ask questions. Attitude among docs are variable, could be cavalier and or condesending (ask-OHIO STATE-our brothern herein what his potential surgeon said-if you wish to mention it, my friend-I leave it to your discretion to answer) or the opposite and could be ultra caring, probably good for the patient to assess your doc, as he assess's you as a patient. If you were (OhioStates) as his patient you would be shocked to say the least after hearing the way it was put to him.  (OhioState-are you weighing on this?).

That's all folks, beeep-beeep-beeeep back later

Post Edited (zufus) : 1/6/2009 6:13:43 PM (GMT-7)


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 688
   Posted 1/6/2009 10:37 PM (GMT -7)   
One more point of clarification, I wanted to be clear that this is also not a non-endorsement (double negative, anyone?). The discussion seems to be that this is a respectable doctor with an interesting option. At first blush, it doesn't seem all that compelling, but maybe it wasn't described well enough on the website.
DJ

Age 53
PSA 2007 about 2
PSA 2008 4.3
Diagnosed September 2008.
Biopsy: 6 of 12 cores positive
Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter removed on 7th day, replaced on 8th day, removed again 14th day following negative cystogram
pT2c
lymph nodes negative
microscopic margins
next PSA 1/22/08


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 1/7/2009 9:47 AM (GMT -7)   
98% of patients prefer the 'through the abdomen' method? So, all of those guys had both procedures? Not likely. Each of us has different experiences, but the catheter was a very, very minor inconvenience - actually, preferable at the time to needing to get up/down to the bathroom.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/7/2009 2:56 PM (GMT -7)   
Ohio, with choices like that, don't blame you at all for wanting to keep getting opinions. That first choice sounds so very drastic, not playing doctor here, but sounds so extreme. I wish you well in your search and decision process.

David in SC
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, further tests/treatments 1/9/8.
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 

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