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Post surgical continence, ED issues - is open, lap or robotic better?

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Posted 2/5/2009 5:14 PM (GMT 0)
Sloan-Kettering apprarently has data which shows that open RP yields somewhat better results than manual LAP and much better results than robotic LAP when it comes to urinary and ED post surgical complications.

Have any of you guys heard this from your surgeons?  I was under the impression that it was just the opposite - that robotic, with its 3D imaging and 10x magnification, allowed the surgeon to be more precise.

Tony

Posted 2/5/2009 5:53 PM (GMT 0)
Good question Tony...my uro/surgeon said the same thing you just said. But I think that you can find all sorts of studies that will put you on either side of the fence with similar data to back up their thoughts. Honestly...I doubt very seriously that any one form of surgery is going to be better than another form of surgery. Surgery is all in the skill of the hands of the doctor...regardless of the method used to do the surgery.

Makes it tough to decide doesn't it...
Posted 2/5/2009 5:54 PM (GMT 0)
Hi Tony:

Even though I did not choose surgery, I researched it a lot and would have chosen robotic had I wanted surgery.  The research I did showed just the opposite of what you are hearing from Sloan.  Here is an example from Henry Ford:

http://www.henryfordhealth.org/19085.cfm

Before accept you what you are hearing as gospel, I recommend you ask to see the study in writing to which your source is referring....

Also, please remember that a very key point in any of the procedures is to make sure you get an EXPEIENCED (300+) practitioner.

Good luck.

Tudpock

Posted 2/5/2009 6:02 PM (GMT 0)
I had my mind all made up to go the robotic route but my urologist, who I really trust/like, recommended RRP instead stating that he did both but preferred the visibility offered by the open surgery, particularly when it came to palpably-detected PC. Among all the studies I read was one by Duke Univ that stated that the ratio of men having second thoughts about the approach they took was higher for robotic that for any other of the approaches.

That's the prob. There are studies out there that will justify any choice made so I say go with the recommendation of a urologist you trust. My guess is that the final outcome will be about the same.

Good lick,
Garth
Posted 2/5/2009 6:11 PM (GMT 0)
Tony,

Is this the study you are referring too?

http://prostatecancerinfolink.net/treatment/first-line-localized/comparative-data-treatment-early-stage-localized-prostate-cancer/lrp-vs-rrp/
Posted 2/5/2009 7:25 PM (GMT 0)

http://prostatecancerinfolink.net/treatment/first-line-localized/comparative-data-treatment-early-stage-localized-prostate-cancer/lrp-vs-rrp/#comment-572

When reading this link referred to above, be sure to read the critics comments.  What we are dealing with here is EGO...Some of these suppose great technical doctors are acting like a bunch of 12 year old boys.  It makes it more difficult for us to make good decisions. 

To me this kind of a self serving study would make me run away from Sloan Kettering as fast as I could.  I know, I know they have a great reputation, but when the doctors let their ego get in the way it can only hurt the patients.

I find this kind of misleading study to be very dangerous.  Shame on SK and some of their "great" doctors.

Posted 2/5/2009 8:08 PM (GMT 0)
All:

Thanks for the feedback. As usual, it's very helpful and knowlegable. The Sloan study cited is a comparison between LAP and open RP and doesn't seem to include robotic LAP. The Henry Ford study is right on point and the results are pretty impressive. Makes you want to hop on a plane to Detroit.

Lots more consults and opinions to go - thanks.

Tony
Posted 2/5/2009 8:16 PM (GMT 0)
My simple take at this point, is the skill and confidence of the surgeon, not the exact method. opens are still good for "large thick" men, and if there are any complications that weren't known ahead of time. From being on this site a few months, I am not sure there is any rhyme or reason to side affects when comparing open to robotics, correct me if I am wrong there.

David in SC
Posted 2/5/2009 8:23 PM (GMT 0)

My urologist/surgeon had the opposite opinion of robotic in that it was not as precise as open. He is a partner with two surgeons who have performed over 750 robotics. When they looked at my case, all three recommended the open RP.

My incontinence ended in 8 weeks and I am progressing very well with the ED.

Posted 2/5/2009 9:42 PM (GMT 0)

IMHO and in my case, I have chosen open (RRP) with a surgeon that has done over 2500 and done many RALP.

With high content and high number of hits on biospy, and numerous dx prostatitis (potential scar tissue affecting surgery), this is what I have chosen at this time. His and his dept comments were that IC seems to have better outcome with open than robotic...in cases like mine, particularly.

They usually try to save one if not both nerve bundles during procedure to retain some erectile function in the future. I would rather have that done by a very experienced surgeon open, than one less experienced on robotics.

I was sold initially on robotic. To me, it was tech's got to be better....the better and newer...the better.  After a lot of research, the shine came off that thought for me and I had to look at what was best for me. RRP will mean a longer recovery time than RALP. That is fine with me if I have a chance at better IC and perhaps ED...again...in my case...and with a very experienced surgeon having solid knowledge of both techniques.

If I had 1%-5% on one core of 8 or 12 or saturation, it would still be cancer. However, I would have more time to think of treatment and when...and would have chosen active survellience for at least the short term (other imaging and more biopsies) while I reviewed my options again.

My nickel's worth.

Mike

Posted 2/5/2009 10:11 PM (GMT 0)
My surgeon stated he trained for robotic at Henry Ford. After 500 open and 350 robotic procedures he doesn't do open anymore. One night stay in the hospital. Only asked for pain meds once in recovery none after that. It sure was nice to get that catheter out 6 days after surgery. After knee and gallbladder surgery, I'm pretty impressed with robotic.
Posted 2/5/2009 10:22 PM (GMT 0)
Sandstorm,

In your case, you make a good case for robotic. I had 4 full days in the hospital and needed them all after my open (though I expected this), and was on regular doses of pain meds for the first 10 days at home, and was weaned off entirely before 3 week mark.

I had my gallbladder out in the old days (1981). I have a six inch incision to prove it, lol, was in the hospital 10 days, and took months after to fully recovery. I was only 29 at the time. See how things have changed so much, now I understand its a fairly simple day surgery with no overnight.
Posted 2/5/2009 10:31 PM (GMT 0)
I interviewed Four surgeons in NYC for my surgery and they all agreed that open RRP had a faster continence than Robotic....even the doc I eventually went with and had Robotic said that this was the case. He felt that ED was faster recovery with Robotic.
BUT it is all in the skill of the surgeon and then each man is different. I was in an awful lot of pain after robotic...and i've had two back surgeries. Some guys are golfing in a week! My continence was fine. ED is a challenge, I was in perfect shape 10 weeks out, but it disappeared. Getting better now slowly. So, don't second guess yourself. Once you make the decision, it was the right decision for you. Don't let anyone make you doubt yourself. Go with your gut. Each of us have different baggage and feelings.

Paul
Posted 2/5/2009 10:34 PM (GMT 0)
Personally, I think that the surgeon and the individual have more to do with recovery than the type of surgery.

At 51 I had robotic Dec 30 and had catheter in for 15 days and for all practical purposes had no incontinence to speak of after removal.

ED is a little different story but had one bundle of nerves taken. Using vacuum and 20mg Cialis every other day and it is slowly coming along after a month - but quite a ways to go. My doctor told me some of this is how hard you work on it daily to keep blood circulating.
Posted 2/5/2009 11:34 PM (GMT 0)

Greetings, everyone.  I am inclined to agree with a couple of earlier posters in that the most important factor is the skill of the surgeon.  You  need to have confidence in your surgeon and make up your mind and go with what you are comfortable with.  For me, I was referred to a surgeon who spent considerable time with me going over options.  He said that he thought robotics was the wave of the future but not quite yet.  He indicated he had done it a few times and had partners who did robotics almost exclusively.  However, for now he still liked to open you up and have a good look around in doing RRP.  He has been doing this surgery for a little over 20 years.  He does 3 a day on Mondays and Wednesdays so does around 300 a year - very experienced. 

He also keeps track of ED and Incontinence issues in his patients. He indicated that short term he expected all his patients to have issues with both.  However, at the 2 year point after surgery 90% of his patients who could get erections before surgery could get them again and that 92% of his patients did not have incontinence issues (at the 2 year point).  My experience was even better - no incontinence after 3 days post catheter and erections right after catheter removal.  Yes, I did as he requested and took Cialis/Levitra (settled on generic Levitra from ADC) and continue to do so 2 times a week. 

Find the surgeon that you are comfortable with and listen to him. David

Posted 2/6/2009 5:30 PM (GMT 0)

I agree that the skill of the surgeon is the most important factor. I had robotic August 08, one day stay in the hospital. I only took three of the pain pills. I had the catheter in for 8 days. Incontinence was a small issue for about 2 months then dry as a bone.

ED was an issue immediately after the surgery but at the five month mark I'm back to 90 -95% with 20mg cialis.

If I had to do it again I'd go the same route with the same doctor.

George

Posted 2/6/2009 6:23 PM (GMT 0)
Jersey, you might want to change your signature, above, you say you had robotic, but your signature says open.
Posted 2/6/2009 7:11 PM (GMT 0)
Thanks Purgatory, it is done.

Posted 2/6/2009 7:14 PM (GMT 0)
jersey, cool, wasn't try to nit pick, just thought i might confuse somebody new
Posted 2/8/2009 1:04 AM (GMT 0)
I recently read a statement from Dr Sardino at Slone Kettering. He states that the data from all prostate surgeries done at Slone Kettering only 60% were considered effective, defined as PC cured, no complications, and no long term side affects. Which means that 40% were not effective. If these results are from Slone Kettering we can only guess at the effectiveness of lesser known surgical centers.
JohnT
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