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Nerve sparing robotic prostectomy?

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Posted 11/4/2013 4:32 AM (GMT 0)
Umm! I don't think so Joseph. and I sincerely hope you do indeed " fully consult" and really, really " fully understand" What the doctors tell you and what you read in you research. This is a good place to learn. At least you are hot, I like that in a human being. Have an uneventful recovery and wish you many happy years of life. Old uh, bet I would beat you in any endurance contest, physical or otherwise, whippersnapper. Always wanted to use that word in a sentence.
Posted 11/4/2013 4:37 AM (GMT 0)
Thanks for clearing that up Tony. BTW I think you said you would be at he Hilton Hawaiian village. If so , even if not, check out the group Olamana fri and sat nite in the Tapa room at said hotel. Trust me you will feel the local aloha from that group.
Posted 11/4/2013 4:38 AM (GMT 0)

logoslidat said...
You mean the " protruding" ones are in fact part of the tease? or are they clipped in your opinion don't think so, but could be wrong. To clarify Pn i is agreed on by most specialists as prognostic in biopsy. Not in the way you state it tho. There are many nerves inside the prostate. None of them have anything to do with effecting a penile response


Agree that the nerves in the prostate are non-erectile, but after they leave the prostate they run into the same neurovascular bundles as the erectile nerves that run past the prostate to the penis. So only these non-erectile nerves (and prostate blood vessels) that branch off the NVB into the prostate are clipped. The rest of the NVB is left intact and teased away. Manipulating and stretching the erectile nerves that are spared causes injury that may take 1-2 years to heal.


logoslidat said...
The path is in the free space around {peri} the nerves { neural}. Invasion refers to the invasion in to the that space not into nerve bundles... the travel way is the space around the nerve, not three the nerves. Im talking nonerectile nerves inside the prostate.


Yes PNI refers to invasion of the space around the nerve, not the nerve itself. But you may be confusing the bundle with the nerve, The bundle is just that -- a collection of thousands of individual nerves -- each with a space around it that can be invaded. So the bundle can be invaded through PNI even though the individual nerves in the bundle are not invaded. At least that is my understanding.
Posted 11/4/2013 4:57 AM (GMT 0)
no the nerves that are being invaded are the non erectile nerves inside the prostate being invaded by the cancer inside the prostate. Once that occurs it affords the pathway, the peri{around} the nerves {neural}inside the prostate, allowing the cancer to then spread epe wise and take the bundle and eventually all the tiny little nerves in that bundle, all now erectile nerves after using the non erectile nerve passage way. Pni can cause an escape any where they go on any part of the capsule the non erectile nerves happen to be . Its confusing but re read my posts and see if you see the logic. I'm not so sure about the clipping part is anywhere. that seems to create a break in the nerve that would render it useless, but frankly that is not a major issue to me at this point. You may be nearer an appt meant than me with a urologist, Im only with GP at this point. I won't see one un less I recure or have some other urological problem. but I will investigate the whole nerve schtick and see hoe it does send the brain its message.
Posted 11/4/2013 5:04 AM (GMT 0)
Joseph I understand completely, remember a young fellow like yourself reveals a lot about them selves to those older than them by their words. learn about the ignore button, it will soothe you. Our fun is over at this point. Oh I agree mostly with your characterization of me. let me know when you open your finishing school for men, I'll apply if you will have me . I will be deleting any other posting I receive from you, but write it any way, that way you will have the last logos. Gosh guys like you bring out the worst in me. Your so easy. Im absolutely shameful at times. Oh well Ill try to get it right tomorrow, really
Posted 11/4/2013 5:06 AM (GMT 0)
Logo

What you just posted is essentially what is stated in the link I posted for you to read. You are simply brilliant.
Posted 11/4/2013 8:07 AM (GMT 0)
I could prove without a doubt that you researched PNI between my challenge to you and your posting of the link. You had no idea that PNI referred to anything other than Erectile nerves, having no idea that it refers to no other nerves than the nonerectile nerves within the prostate You probabaly still think the holes he is referring to are periaround the nvb runner nervesnueral as you call them.in other words you think the cancer spreads to the nvb via an invasion of the nvb runners that you think are inside and than on to the nerve bundle. This after reading the blog of the prostate dr, who explained it rather well. I f you do you are wrong and there is no way at this point that you will take that correction from me due to a ego related bias. It does not and if you read the blog again with objective thought you will see this. Also reread my post the same way and you might see the logic, that I assure you did not come from the so called prostate Doc. You might even research him. There is something in past posts here about him, that gives me a feeling he is not a doctor at all but a real educated student o f Pca that started that as a blog and he is very well informed tho I have issue in the way even he explained it. He spammed this site in the past trolling for readers. I am thru responding to you, but do feel the experience has been enlightening due to the back and forth between you, myself and njs.
Posted 11/4/2013 8:48 AM (GMT 0)
Logo,
T- 10 days. I am Hawaii bound. Landing in Honolulu on the 13th. I must work. Somebody has to do it. I say it will be my sacrifice....lol

Tony
Posted 11/4/2013 11:51 AM (GMT 0)
Guys, I had to edit a few posts for violation of Rule 3. Here it is again as a reminder:

3. No posts that attack, insult, flame, defame, or abuse others. Respect other members' opinions regarding treatment decisions. Decisions about health and well-being are highly personal choices. We should respect all points of view. Flaming will not be tolerated.

Thank you in advance for getting back to the subject at hand and doing so in a civil manner that does not insult fellow members.

Jim
Posted 11/4/2013 1:53 PM (GMT 0)

logoslidat said...
I'm not so sure about the clipping part is anywhere. that seems to create a break in the nerve that would render it useless...

Again, I would refer you to the figure 8.5 in Dr. Walsh's book. The two NVBs go from the sacrum to the urethra running right past the prostate. Several branches come off the NVBs into the prostate. These branches are clipped to release the NVBs from the prostate but the main NVBs themselves that run past the prostate (including the erectile nerves to the penis) are left intact.
Posted 11/4/2013 2:47 PM (GMT 0)
I am exiting the forum and shall not return.

(Comments deleted by Moderator - violation of Rule 3)

Joseph, I'm sorry the forum did not meet your expectations but we wish you well - Jim (Tudpock18)

Post Edited By Moderator (Tudpock18) : 11/4/2013 9:23:10 AM (GMT-7)

Posted 11/4/2013 4:48 PM (GMT 0)
Tudpock18

Instead of deleting my post which is absolute truth. You should let it stand so others can read and consider whether they want the medical advice of the forum's pseudo doctors including (name deleted by Moderator).
(name deleted by Moderator) initial response to me was simply uncalled for and quite frankly he was dead wrong. The decisions people make regarding their surgery carry risk and have life or death outcomes. Instead of responding in a dignified manner he was much like a loose canon. He owes an apology and I would respectfully suggest he not practice medicine.

It is people like (name deleted by Moderator) and the abhorrent behavior which did not meet my expecations.

Post Edited By Moderator (Tudpock18) : 11/4/2013 10:36:31 AM (GMT-7)

Posted 11/4/2013 5:16 PM (GMT 0)
Joseph, based on your last post I'm guessing Tud reached out to you via e-mail - something that I know he and the other Mods do frequently when they sense issues brewing. . . . . tough job they have, for sure.

I would simply say don't let the banter push you out of the game here. . . . I agree that at times it can be frustrating, in fact I've thought more than once about checking out of here as well. But then I (personally) come back to two things - 1) Ain't nothin' stopping me from being here for the newbies that need my (our) help, and 2) Read through the egos and draw the good, and toss out the BS.

Hope you hang around, but it's your call of course.....
Posted 11/4/2013 5:37 PM (GMT 0)
NJS, I do see the tributary like spread which could appear to an eye as penetrating the prostate itself or the prostate capsule{the pkg wrapping the gland as, walsh puts it} . The diagram definitely shows they are clipped at this point. I maintain they are in the capsule not the prostate. This is not splitting hairs imo. Walsh goes on to say about PNI " because the nerves, interior nerves are close to the edge of the prostate. He did not say close to the edge of the prostate right by the nerve bundles, tho they are there also.. To me that statement indicate they are interior. I think we have already agreed on these points actually. I do agree that I hone points finer, in a descriptive way,not value added, tho I do, do it to add value . The previous statement is as not contradictory as it may appear if you really read it correctly. Anyway I digress. Ok NJS I am on board with you here. It was fun to have a dialogue , in the socratic dialectic sense, rather the a debate as to who is right and who is wrong.
Posted 11/4/2013 5:41 PM (GMT 0)
Joseph, here's the deal. You are perfectly entitled to your opinions, including your opinions of any of the other members, However, Rule #3 insists that you not make insulting comments about those members -- as mods we do not have the luxury of picking sides and allowing flames by some and not by others.

If you disagree with another member you should feel free to provide facts, opinions and logic that debunks their positions. However, we ask that you please not refer to them with pejorative comments and to carry on the discourse in a civil manner.

As Yooper suggested, I would be happy to discuss this with you directly via email. However, you do not have an email listed in your profile. Please feel free to email me if you want to discuss this further and I will respond quickly.

Thank you for your understanding.

Jim
Posted 11/4/2013 6:13 PM (GMT 0)
Joseph, I was not wrong in my understanding PNI, you were. This is unqualified on my part. We could agree to disagree. Your post that prompted , in a neutral way, this incident would translate to most people some what in the know, including yourself , if you could read it more objectively, that you felt the tendrils the Njs referred to, protruded deep in the prostate and that these, nerves. are what causes epe. It is the inner nerves that pni refers to, when cancer breaks thru their pathway, they will, in fact, effect nvb invasion, seminal invasion,etc. Walsh is explicit when He describes pni. This explanation was written in a paragraph far removed from nvb invasion. Pni is an avenue for EPE, near the nvb, and also in the 360degree sphere near the inside edge of the gland, not the capsule, the gland. You did not know this and and will not admit this fact. I pointed it out to you, in a firm way,colored by the frustration of seeing this a lot by newbies who get pieces of information put them together in a incorrect fashion and pass them off without any qualification whatsoever, as a medico would. I felt then and feel now this is dangerous and I call it when I see it. In the future I will try to take a breather after discovering such so as to defuse my frustration before writing. I do apologize for any real or perceived slights I have caused you. But I do stand by my statements,except for my biting sarcasm to make a point. It is unfortunate That the moderator removed a lot of your and my posts in that the whole forum could judge for them selves. He edited som and removed some. That is his prerogative as a Mod and I support him fully in his approach to a thankless job. I wouldn't do it. Id be too much of a h--d , to you use your vernacular, which incidentally was the first folly, {meant volley but spell check enhanced the thought} thrown, a--
Many of us here, have wanted to quit, but most, myself included, come back. Joseph prove to your self, that you can endure the negatives of Healingwell , better than me and at least keep it a tie by staying. Regards
Posted 11/4/2013 11:33 PM (GMT 0)

logoslidat said...
NJS, I do see the tributary like spread which could appear to an eye as penetrating the prostate itself or the prostate capsule{the pkg wrapping the gland as, walsh puts it} . The diagram definitely shows they are clipped at this point. I maintain they are in the capsule not the prostate. This is not splitting hairs imo.


Here is a paper on the topic: Anatomical studies of the neurovascular bundle and cavernosal nerves

The following excerpt clearly states that the nerves and blood vessels that go through the capsule into the prostate branch from the same NVBs that contain the erectile (cavernosal) nerves:

The nerves running in the NVB innervate the corpora cavernosa [erectile chambers], rectum, prostate and levator ani musculature. The last three also receive a vascular supply from vessels coursing in the NVB. In 20 of the 24 dissections, a large vein drained the rectum, piercing the pararectal fascia and entering the rectal musculature on its anterolateral surface at a variable level, ranging from mid-prostatic to prostatic apex (Fig. 6). Artery and nerve branches supply the anterolateral wall of the rectum from the prostatic apex to midprostate level. Nerves running in the NVB pass through slit-like openings in the lateral pelvic fascia to innervate the superior and middle sections of the levator ani musculature. Many nerve and vascular branches pierce the lateral pelvic fascia distally to supply the inferior portion. The nerves innervating the posterior aspect of the prostate are intimately associated with capsular arteries and veins of the prostate. These structures penetrate the prostatic capsule along its base, mid-portion and apex.

logoslidat said...
Walsh goes on to say about PNI " because the nerves, interior nerves are close to the edge of the prostate. He did not say close to the edge of the prostate right by the nerve bundles, tho they are there also.. To me that statement indicate they are interior. I think we have already agreed on these points actually.


My understanding is that PNI can occur anywhere cancer invades the space around nerves -- both inside the prostate and also potentially outside for stage T3 disease. In the context of prostate cancer however, PNI is most often discussed as a finding on biopsy, which is tissue taken from inside the prostate.
Posted 11/4/2013 11:57 PM (GMT 0)
I am totally in synch with your last paragraph. And the paper does say the capsule is penetrated not the gland, again an arguable distinction. We are on the same page, tho minor editing from both points of view are arguably possible. BTW I made a minor edit to my post in the 360spherical section to clarify my point, if you are interested. Reenforcin my point that pni is possible pathway out side the gland and capsule at any place there are interior nerves inside the sphere, I feel Walsh makes this point in his discussion on PNI, which discussion, is far removed from potency issues later discussed. He seems to pooh pooh prognostic value of pni for long term survival . But I have an older edition. Regards
Posted 11/5/2013 12:55 AM (GMT 0)

logoslidat said...
the paper does say the capsule is penetrated not the gland, again an arguable distinction


I don't think there is any doubt. It says these nerves innervate the gland. These are autonomic nerves -- both sympathetic and parasympathetic -- to the prostate that regulate the function of the gland.
Posted 11/5/2013 1:02 AM (GMT 0)
Also see slide 5 of the following animation: urology.jhu.edu/prostate/1.swf
Posted 11/5/2013 1:58 AM (GMT 0)
Ok I will do that. Without getting too much into it, my first mental response, was answered by the sympathetic and parasympathetic. You are good it trying to figure the counterpoints mental response and answering it before it is asked. Thats exactly what I did in ATC. the only response I wanted from the pilot was affirmative and negative, preferably affirmative. If i didn't get the response I wanted I hadn't thought out the situation thoroughly from the pilots situation, and times a wasting on a busy sector. Ok the slides
Posted 11/5/2013 2:29 AM (GMT 0)
Beautiful slides, revealing. If I had your drive I would study them further and may, but I would rather see this in a classroom and have a back and forth with the prof/you. Thanks for the clinic.
Posted 11/5/2013 12:27 PM (GMT 0)
I had nerve sparring RALP in June 2011, I was 61 but I had been using Viagra for several years for ED caused by my hypertension meds. My prostate was very large (69grms) and 60% tumor involved. My URO also had over 600 surgeries with the robot but he told me my nerves were traumatized when my large prostate was removed and 2 1/2 years later I have 100% ED and use injections. Sex is no where close to what it was before.  I am 100% continent and cancer free for now so I do not complain, I would not trade this for not having ED.

 

Terry
Posted 11/5/2013 5:58 PM (GMT 0)
Urgh, what a mess.

Joseph, Questionaboutit,

Email me if you like. We're usually better than this.
Posted 11/6/2013 4:39 AM (GMT 0)

questionaboutit said...
I am ok with it all. I just think we should all be modest in our claims to knowledge. I have shown my many Uros some of the posts here by those that seem to have great knowledge when the information caused me to question something about my case. In every instance the real dr has demolished the information provided by the forum experts.
I talk to lots of guys with PCa because I have told the world I have it so they tend to find me. I limit my advice to go slow, get as many DOCTOR opinions as possible, read and be sure you understand Gleason grades and options but mostly find a dr you trust. I don't have the audacity to give medical advice. I hope no one makes any decision about nerve sparing or non sparing based on these posts. Stick to support.

I'm not sure just who you are implicating with your comments, but as someone who contributed much of the information in this thread I'd like to provide my perspective.

While I agree in principle with your advice to see multiple good doctors to get as much information and advice as possible and then thoroughly understand your options, as a practical matter not everyone has the wherewithal (in terms of health care access and/or intellectually) to do it that way.

The best way I can provide support and "pay it forward" is to share some of the information and understanding that I have been fortunate enough to gain. But I strive to offer information (with citations to literature wherever possible) versus advice and in no way do I pose as a physician.

Post Edited (njs) : 11/5/2013 9:42:29 PM (GMT-7)

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