"Enhancements" to the nerve-sparing prostatectomy

In my obsessive searching on the internet, I have come across a number of terms and techniques that are evidently "enhancements" to the nerve-sparing prostatectomy:

Bladder neck sparing is not the gold mine they had hoped. Risks an area typical for cancer cells to escape and isn't showing much value in preventing incontinence following a prostatectomy.

Nerve grafting is starting to see some promising evidence however, no one in our forum has had one done so it's all in what ya read in the journals so far. U of M had done 67 grafts by 2005 and claim none had taken as of then. I should ask Paul's Uro how they're doing now.

Veil of Aphrodite is a procedure that saves much of the protective layer of tissue surrounding the nerve bundles therefore preventing some of the typical truama associated with nerve sparing This sparing technique was developed by Menon and Company in Detroit h as been in practice for about 2 years now. HE claims it is a success.

Urethra sparing...just reading stuff on that now...no opinion. Makes sense to leave a little if it's safe.

Seminal tip sparing. A not so new idea that many claim helps retain better urinary function and possibly erectile function. Many surgeons do this as a matter of practice whenever they can. The possible reason it helps? Not as truamatic on the surrounding nerves and tissues to leave a few mm of the seminal vesicle. Not all patients are candidates for this.

Paul had a plastics man on standby in case a nerve graft was required....it wasn't. His surgeon did spare both the nerves (well, all but a little of the left side..it was stubborn) and seminal tips. Can't recall exactly how much of the tips without looking at the surgical notes but, it was 3-5 mm of tissue. Hard to know if these things worked but, he had nary a day of leakage :>)

Swim

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  Swim ~ thank you for you!!!!! 

Here's a thread started by Joes411

Veil of Aphrodite ?

 

Thanks Bluebird...and a big hug for you too!

I really don't sit and read all the time. My computer time is in spurts. The vast majority of what I read dates back over 2 years when Paul was diagnosed and my hand was in recovery. Boredom breeds I guess. Now it's a matter of keeping up on some of the old stuff. Thanks to this forum, my bank of material is endless :>)

Swim

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So many people on this forum are amazing in the knowledge they have acquired and can share with those of us that are either completely baffled by some of the more arcane issues or too lazy to research and really understand them. Swimom, you are truly a godsend. I thought you MUST be an MD or RN/RNP. Whatever your "professional qualifications," I always know that you will give us the most complete and updated information available. Thank you!!

puget

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Puget

Thank you Puget, you're so sweet!

I am not a nurse, not a physician or a Bluebird :>) Can't come close to what they do! I'm a Medic / EMS educator by profession..or by passion as I like to call it. It helps to have an anatomy/physiology background when sifting through the mounds of medical information there is on any health concern. Paramedics are trained to read and obsorb material quickly. I guess I got that part down pretty good. Now, if I could only remember where I put my car keys!!!

Swim

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Swim & CaPCA,

Thanks for the information.

My surgeon team also practices leaving the Veil of Aphrodite and a few mm of the seminal tips where applicable (leaning toward caution, for sure!).

To enhance nerve-sparing during a daVinci procedure, my surgeon in Austin, Dr. F.a.g.i.n, avoids using heated instruments (cauterization) when working in the area of the nerve bundles. Avoiding heat near the nerves reduces the surgical trauma on the nerves when able to be spared.  It is his opinion that this approach improves recovery of the spared nerve bundles.