Veil of Aphrodite ?

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Joes411
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Date Joined Mar 2007
Total Posts : 87
   Posted 3/9/2007 8:59 AM (GMT -7)   
 

The Veil of Aphrodite method of nerve preservation in Prostatectomy is practiced at Henry Ford Hospital and by a few of the Doc’s trained at Henry Ford who have moved on to other hospitals. They have been practicing this procedure at Henry Ford now for a few years.  The ED outcomes reported by Henry Ford using the procedure are far superior than reported at some of the other major hospitals that practice the standard Bi-lateral nerve preservation technique.

 

Reported outcomes per websites:

Henry Ford potency at 12 months 97%

John Hopkins potency at 12 months 72% - 82%

 

I read a Jun06 article in Uro Today about a study on the Veil of Aphrodite procedure that also reported superior outcomes.

 

I’m wondering………

  

If the Veil of Aphrodite is that much better why isn’t it more widely adopted?

 

Is this just a matter of how the numbers are being presented?

 

 

Joe

 


Age: 51

PSA  Jun06  4.1  (PSA Jun05  1.2)

1st Biopsy Nov06 – Atypical cells but no cancer

2nd Biopsy Jan07 – 1 of 16 cores positive

Stage T1c   Gleason  3+3=6

 


Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 3/9/2007 9:44 AM (GMT -7)   
Joe,

That would be because, according to Dr. Menon "his" outcomes are better. These have not been echoed by others necessarily. There is nothing wrong with using the newer procedure. There just isn't enough information on the outcomes yet to brag much. Menon may not have this prostatectomy market cornered anymore either. More and more surgeons out there are equally talanted now. That's what happens when news of a good thing gets out. Everyone wants a peice of the action.

Savatta also has amamzing outcomes data. I have heard from a several people that in their case, it's true. If I were to see someone today I'd give serious thought to Savatta and we live just miles from Henry Ford. Savatta posts now and then on Low Blow.

Paul

Jeff 11
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Date Joined Jun 2006
Total Posts : 24
   Posted 3/9/2007 12:34 PM (GMT -7)   
Hi I had surgery with Dr. Menon 6/29/06 & had my erectile function back in 6 weeks without any medication. Good Luck

Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 3/9/2007 1:27 PM (GMT -7)   
Good news Jeff. Menon is absolutly one of the artists.

I guess Paul's point to Joe was that there are others who have very, very good outcomes so look around before taking a long trip. There could be a guy right next door.

Swim

B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 3/10/2007 8:48 AM (GMT -7)   

Dear Joe,

I did a lot of research after my husband, age 51, was diagnosed on Dec 5, 06 (Gleason 3+3, T1C, PSA 4.3). His diagnosis was purely PSA driven, and his biopsy showed less than 10% of cells, 4 out of 12 core samples, one side of the prostate only. It became obvious that the robot assisted laparoscopic, nerve sparing proceedure was our treatment of choice and I called the Henry Ford Center for a recommendation on a California surgeon.  My extensive research had led me to believe that the "Veil of Aphrodite" was only a trademark for nerve sparing surgery by Dr. Menon, and I took the percentages of regained potency quoted by this and various other doctors with a grain of salt.  There hasn't been enough time since robot assist, laparoscopic, nerve sparing surgery has been used to gather definitive statistics, in my opinion.  I don't know where you reside, but I can tell you that we went to Dr. Ahlering at UC Irvine, where the Da Vinci machines were developed. By the way, Henry Ford could not recommend a surgeon, but the person there did reiterate that UCI developed the machines they use.  My husband had the surgery on Feb 27, 2007 and had the catheter removed on Mar 6. He had immediate, full continence and (surprisingly) immediate and regular tumescence. Still too sore to attempt intercourse, as he also had two hernias that the doctor repaired, he has already had an erection strong enough for it.  He appears to be in the 30%-50% of men who gain immediate function.  Dr. Ahlering prescribes Viagra (1/4 pill 25mg) per night starting the night after surgery. He also recommends that one continues to take it even if erections are achieved.  Both my husband and I feel that doing everything one can do is important.  On that note, we ate a 60% vegan diet (still had fish and eggs sometimes), went to a support group and tried something that no one has mentioned yet in any venue:  Reiki.  This kind of healing seemed to energize the whole pelvic area as well as create a regular meditation that was most positive, relaxing and fear-relieving.  His last PSA before surgery was down to 3.9.  One last note, the pathology showed cancer in both lobes, with Gleason still at 3+3, negative margins. We are glad we didn't wait, although we had considered it.  Removal while still contained and while the prostate is not too enlarged is optimum.  One last thing, diagnosis in younger men is on the rise, thanks to PSA. I looked specifically for cases and personal postings that my husband could relate to at his age. I hope this helps. Best wishes to you!

Becky


Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 3/10/2007 10:29 AM (GMT -7)   
Becky,

Thanks for your input. Every piece of info helps someone. Thank God for a great pathology by the way!!!

Hopefully Joe will do as well as your husband has done but, I must warn men...no way in studies does between 30 and 50% of men regain immediate function after a prostatectomy. Not to sound like a know-it-all but figure is just not that high. In the neighborhood of 70% of men under 60 will eventually regain good erectile function with or without an aid. Approximately 20% is lost for good in most cases. Some damage occurs even under perfect conditions. Continence isn't even 50% right out of the shoot and I know the chances of that is higher than nerve function. I will admit, surgeons have improved even over the last 2 years but, not that much. I am hearing wonderful results that were't being echoed just 2 years ago when my husband had surgery. He had full continence but not function. That took a while and is still improving....he was 48.

Your surgeon followed what appears to be a protocol being used by a lot others with the used of PDE5's. Hopefully that will translate into perscription costs on meds dropping in the near future. Setting protocols for drug companies unfortunately means doing studies and doing studies takes time and consistancy and money. There just are not many resarch dollars being freed up for something men will pay for at any cost. They basically got men by the gonads on this one still. As long as pills for depression are standard and erections are considered recreational, we're going to have to wait till the price drops on these drugs as the market becomes flooded.
***

As for the Veil of Aphrodite...it is nerve sparing with the a twist. Menon gave his twist a pretty cool name eh?
There is so much competition between Doc's in this area with 4 research/teaching hospital complexes. Everyone is out there trying to set new medical trends. Menon is among the very best simply because he's done so many of the surgeires. There are plenty of artists all over the country including Ahlering. I have run accross some of his articles while reading some 10,000 studies and research articles on PCa. Ahlering big into rehab very early on. He was one of the first to begin giving oral PDE5 drugs the day of or after surgery. A trend setter! He sounds like a Doc to be seriously considered by any man.

A thin (veil of aphrodite) connective membrane is still intact from what I've read. There is less stretching and supposedly less damage done to the nerves as they are peeled away from the prostate. Still, there are few people using it and even fewer comparison studies. If it works well, soon, all surgeons may be doing the same thing. As long as surgeons keep getting better, someone will find a way to reduce or even eliminate most nerve dysfunction following pelvic surgery. Can't eliminate all of it without doing surgery by osmosis. Cutting in any fashion will cut vessels and nerves...some will not regenerate. Getting away from using heat and using kinder clamps has made a world of difference already.
***

Reike is wonderful! Meditation and massage are wondeful. Homeopathy is wonderful....my husband still got cancer twice! We still practice homeopathy and love a good massage. Reike wasn't Paul's bag but I like it.
Reike could be very useful for promoting healthy blood flow and healthy minds! Willingness to learn alternatives prevents most people from trying them. Modern medicine poo-hoo's the practices so much that people aren't so willing to look outside the box. The University of Michigan is one of a handful of places where the cancer center has an alternative Physician on staff. In fact, Moyad (sp?) posts a quarterly article in PAACT.

Paul and I have relaxation tapes made specifically for us during some hypnotherapy sessions. They are pretty helpful if someone is into that. I am much more into that stuff than he is. Myself and one of our kids did 10 sessions of Rolfing years ago. Anyone with neck or back pain? Rebalancing the body is one way to resolve years of misalignment. Painful but amazing, lasting results! The cost for some of the alternative wellnesss practices is expensive but, it does a body and mind so much good. I'm glad you suggested using a more natural approach. Glad to learn hubby is well on his way to feeling great again!

Swim

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 3/10/2007 9:54 PM (GMT -7)   
Becky, *B&B’s World
Please “start a personal thread” with all the information from your “3” reply postings to others.
This is so important for future members… And ~ we would truly like to welcome you on your thread…
This would be a great gift for so many..... In Friendship ~ Lee & Buddy

mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 3/11/2007 11:14 AM (GMT -7)   

Dear Lee & Buddy,

Thank you for the welcome.  I will do as you suggest and am trying to figure out how to attach my previous replies, but navigating around here is a challenge for me.  The HELP section did not answer my questions so far.  I will do my homework.  Again, thank you!

Becky


Joes411
Regular Member


Date Joined Mar 2007
Total Posts : 87
   Posted 4/27/2007 5:12 PM (GMT -7)   
Bump to top for Carl

Age: 51

PSA  Jun06  4.1  (PSA Jun05  1.2)   DRE negative

1st Biopsy Nov06 – Atypical cells but no cancer

2nd Biopsy Jan07 – 1 of 16 cores positive

Stage T1c   Gleason  3+3=6

DaVinci scheduled for mid May


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 4/27/2007 9:59 PM (GMT -7)   

Hey Joes and Everyone!

This is just a check-in to give a quick report-B's surgery was 8 1/2 weeks ago.  The only bump in the road was about three weeks after surgery (B went back to work 2 weeks after), when he noticed that stress incontinence required a "dick diaper" in his words. (BTW, we sent away for some small "sleeves" that work great) He was a little bummed out about that, but also realized he was back to drinking a lot of tea and coffee. He also had been feeling so normal that he wasn't being conscientious about the Kegel exercises.  Now he contracts his muscles when getting up out of a chair, or before coughing or sneezing and that does the trick-no dribbles.

Still on the nightly 1/4 pill of Viagra, plus 100mg before sex. We count ourselves extremely blessed--morning erections are there like before--night ones no problem either---we didn't expect it but that function came back immediately.

The nerves were spared nicely, according to our Dr. Ahlering. There was no talk of the Veil of Aphrodite, but I would not be surprised if he spared the nerves in the same way as Dr. Menon.  Think about it: if there is a special technique with the RALP regarding the nerves, wouldn't any top notch surgeon (or artist, as Swim would say) using the robot learn it? Any comments on that?

Best to everyone here,

Becky


Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery

Full potency, 12th day after surgery
 
 


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 4/28/2007 11:07 AM (GMT -7)   
Veil of Aphrodite vs. other nerve sparing techniques...
 
Been a while since I've been on the board, but this is a good weekend to start back, and this is a very (IMHO) important thread.  Anyone who is considering Da Vinci (and there are more and more of us every day) is sooner or later going to read of this technique and peruse Dr. Menon's statistics.
 
I want to share what I have learned.
 
The Henry ford/ Menon website was the first place I really learned about Da Vinci so, of course, the "Veil of Aphrodite" became very important for me.  I wanted to learn more about it.  Why don't other doctors use this procedure?  If it is so good, why isn't everyone doing it? Also, as I received materials from Menon's clinic I began to notice what appeared to be a gradation of levels of nerve-sparing, with veil of aphrodite at the pinnacle.
 
As I learned more, and talked to the local Dr with the largest number of surgeries under his belt I came to learn that there were actually quite a few doctors out there with multi-hundreds, 1000+ da vincis under their belts. I eventually learned about Vipul Patel at James Cancer center in Columbus, Ohio.  His statistics and knowledge deeply impressed me.  I started to plan to go to him for treatment.
 
But the "veil of aphrodite" technique kept nagging me in the  back of my mind.  Finally, out of frustration I called Dr. Patel and asked him if he knew about it and whether he used it and whether Menon's technique and results were better than his.  This was uncomfortable and  I felt like I might be potentially making him feel like I didn't trust him.  But his response immediately put me at ease.  He explained that ALL of the top surgeons know one another, have close personal relationships and a very high level of professional respect for one another.  He also explained that he has used the veil of aphrodite technique in the past but has moved on to a technique he calls a "retrograde nerve-sparing" technique.  He explained that he starts by sparing the nerves.  It's the first thing he does, then he moves on to the other physiological features and elements of the surgery.  He says he's found that the single most critical thing for a succesful nerve-sparing surgery, assuming of course that the nerves are not severed, is to not use any heat and a minimal amount of trauma on the nerves.  His technique allows for this and he feels his statistics are among the very very best.  He said his results will soon be published.
 
I do think there is a certain amount of marketing hype involved with the "veil of aphrodite" method.  For one thing, take a look at the price.  $30K.  And here is a specialist performing six or more of these surgeries a day.  Of course, the hospital and other attending doctors are paid, so he's not pocketing 30k for each surgery.  But it is clear that this is a medical specialty which (deservedly) earns the best practitioners a very high income.  I don't begrudge them this!  But it is worth remembering when you are trying to decide where to go for treatment.
 
Best regards,
Markus

Age, 53
PSA 3.76, Gleason 6, T1c, scans negative
psa doubling time 35 months
Still researching and deciding treatment options.  Leaning towards da vinci robotic.


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 4/28/2007 12:23 PM (GMT -7)   
Dear Markus,

Yours is an enlightening response. Thank you

Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery

Full potency, 12th day after surgery
 
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/28/2007 1:23 PM (GMT -7)   
Marcus has a good man on his team! The retrograd...or non cautery surgery, early release of the bundles, along with superior control of the major vessels is what is giving these Doc's their improved outcomes in the last year or so. Anytime bleeding is limited, heat and manipulation are minimalized, nerves and tissues are spared.

Some Doc's are releasing nerves very early which cuts down on the amount of trauma. My guess is that this may only be truely successful in the early stages of cancer. I personally have a concern about margines and wonder.. Is there is any significant difference in margin stats? Is the surgeon doing intraoperative samples to ensure the most favorable outcome? Just my mind wandering....

Swim
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