"Enhancements" to the nerve-sparing prostatectomy

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 8/31/2007 5:05 PM (GMT -7)   
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:
 
1) Partial nerve sparing
2) nerve grafting
3) Veil of Aphrodite
4) bladder neck sparing
5) urethra sparing (same as above?)
6) seminal vesicle tip sparing
 
Which ones are promising and which ones are a joke?
Are there surgeons and/or techniques (i.e. robotic vs. "open" retropubic) that lend themselves to any particular enhancement?
 
Thanks,
 
CaPCA
 
Age:44
Diagnosed 08/21/07 with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
Prior biopsy 3 years ago was negative
Prostate is ~24g
 
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 8/31/2007 5:39 PM (GMT -7)   
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
 


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 8/31/2007 5:49 PM (GMT -7)   

  tongue Swim ~ thank you for you!!!!! 

Here's a thread started by Joes411

Veil of Aphrodite ?

 

 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 8/31/2007 6:18 PM (GMT -7)   
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
 


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 8/31/2007 9:51 PM (GMT -7)   
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
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 8/31/2007 10:43 PM (GMT -7)   
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
 


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 9/1/2007 4:02 AM (GMT -7)   
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!).
They self-report better success on recovery from E.D. where these procedures are possible.
(I personally speculate the seminal tip sparing possibly enhances the sensation of post-surgery orgasm.)

These physicians (Karnik & Shaw in Austin Tx.) also tell me the methodology involved significantly increases the time required for surgery and is one of the main reasons they try to limit themselves to only two (sometimes three) radical prostatectomies a day.

CCedar
ICTHUS!

festus
New Member


Date Joined Jul 2007
Total Posts : 5
   Posted 9/3/2007 9:41 AM (GMT -7)   
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.

TJ Dillon - TX
Diagnosed: May 2007, PSA-3.9, 1 of 12 cores Gleason 7 (3+4)
Treatment: Robotic laparoscopic prostatectomy 8/13/07
Post-op pathology: Confirmed Gleason 7 in left lobe, also Gleason 6 in right lobe, T2c, negative margins, both nerve bundles spared
Recovery: Catheter out 8/21/07

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