With all the controversy that's going on, My question is, what surgical procedure is best for nerve

The questions in your survey are the very ones that there aren't any conclusive studies of at the moment. I think you will find that most here will tell you that its not the surgical method that is used, its the overall experience and expertise of the surgeon that makes the most difference, and even then, there are no guarantees in the side effects departments.

I chose open surgery, as robotic was new and rare in my area at the time. Now they do it all the time here. But we have men here that went to big name surgeons at famous centers, were both side nerve spared, and yet have total ED.

Sounds like the ones you are checking out are fine as far as number of surgeries go, now you need to find out about their real life reputations and better yet, find out about some of their expertise from patients of that partiular doctor.

Good luck to you.

An excellent doctor. Regardless of procedure...

Tony

Had DiVinci Robot procedure in Germany. My urologist tried to talk me out of it. I did a bunch of research on the doctor and his clinic and convinced him. Have five co-workers who all had procedures done within 18 months of mine. Four had open radical, one had robotic. All who had open have or had issues, two of us with the robotic are doing much better
July 2002 PSA 4.0, had continued testing from than through November 2007 with a steady rise to 13.2 All the testing was done, but nobody read the results!
Jan 2008 PSA 14.5
Biopsy 7 of 12 positive
Gleason score 4+3=7
Operation April 9 2008
First erection still in the hospital with cath still in. Did not know the pill the nurse left at night was a Levitra
Minimal incontinence after 30 days, no leakage or accidents after 90 days
Returned to exercise regime in less than 30 days to include walking a 26.2 mile "Volksmarch" through the mountains of southern Germany on my 50th birthday, 22 days after surgery!
Current treatment is 20 mg Levitra 3 x week
Have to agree that an experienced surgeon is key, but good robot beats a good open procedure IMHO

goodlife,
that was a very sensible post, and i think you speak the truth there. every human body is different, even though so similar in many ways. the points you bring up may very well explain the myriad of results we have even among us here at HW. My surgeon didn't tell me this until several months after my main surgery, but he was really upset that he had to do mine starting at 4 PM in the afternoon. He liked to do the big operations in the early morning slots only on a certain day. The hospital thought they were doing me a favor by having the last spot on a Friday afternoon, in order to have the full weekend in the hospital for the roughest part of the recovery. Sounded good to me at the time as the patient ,but in retrospect, would rather had it the way my surgeon wanted it, so that he could operate on me when he felt he was at his best time frame of the day. Not sure it would have changed the end results for me, but we will never know, just another of those many "factors" that determine our ultimate fate.

david in sc

I had open surgery due to the lack of experience in the Robotic field if you are worried about ED and continence ask each doctor what his percentages are for both and ask him to show his figures for both mine had a 95% success rate for continence and 50% for ED which I was happy to go with

The thing that I have been wondering about whether the Robotics are the best in complicated surgeries mine was difficult over 5 hrs and I came out OK on continence and ED (lost one nerve bundle) after watching a video of a Robotic operation I have also wondered if the pincers could be damaging the nerve bundles human fingers will be much more delicate in this department which could account for why the results in Robotic surgery vary so much

My sister in law (nurse) gave me that tip before my daVinci RP four weeks ago. She suggested I ask the surgeon out loud in public, which I did while lying in the pre-op area. Dr. Hu responded he does all the robotics himself but needs two assistants in the room to help with the operation. That was fine by me, although I don't know what I could have done at that point if I had gotten another response from the surgeon.

Red,

I know its academic now, but what you could have done lying in pre-op had you not gotten the answer you wanted, would be to abort the opertation, and rescheddule another time with another doctor. It's your body and your peace of mind.

Like I told my daughter when I walking her down the ailse to get married, that at any point you know in your heart you don't want to do this, then we will turn around and walk out.

We always have choices with our bodies, and that includes surgery.

David in SC

A study in Boston gives the following results after 36 months for patients with normal sexual function before surgery: results are normal function, intermediate; poor.
Non nerve sparing: 6% 31% 63%
Nerve sparing: 8% 28% 64%

The results for nerve sparing and non nerve sparing were similar in the study of radical open. I would imagine similar results for robotic.
JohnT

Especially for GTA:

We were very happy with the Brigham (except for $$ parking!!) - great nursing staff, great care throughout - my hubby even needed another day b/c of excessive drainage and I was stunned that they kept him when my experience has been kicking folks out as long as they are breathing!

Chose open RP b/c our initial meeting was with Dr. Richie and this is his expertise as he quickly told us.  Welcomed us to see Dr. Hu for a consult re robotic procedure but Dr. Hu was traveling and he has busy schedule - concern was waiting too long given Gleason 7.  Dr. Richie also spoke with us about what he could feel with his hands - prostate CA is sticky.  I come from family of surgeons so was comfortable with him and his approach.

My apologies for dropping off this board as things calmed down for us - you all provided enormous support.  One problem is that I returned to work after three weeks and can't log in - too many trigger words that bring down the computer overseers

Happy to report the good news of ZERO PSA .... but also zero erections....that is one of our concerns b/c Dr. Richie takes what seems to be conservative approach compared to many of your stories - no treatment for another 3 months so we'll see.  Meanwhile hubby almost completely continent (except sneezing, or when he's been doing too much yard work and gets really tired) so that's good.  Walking is absolute key.

My best to all of you and my gratitude as well...

GTA, you are doing the best thing for yourself right now by researching and asking questions. I believe many guys simply follow the initial instructions given by their urologist, without question. I could have been one of those guys, if it wasn't for this forum and another one I read daily. From the insight provided by guys who have gone down this road, I learned to get second opinions on my initial PSA, my initial pathology, and in the end, leave my urologist who found my PC and had laid out a plan for me to have surgery by him. At the time, he had done only 40 daVinci robotic surgeries so, again with the counsel from health forums, I new it was vital to find the most experienced surgeon possible. I found two surgeons in New England who had both done over 1,000 da Vinci surgeries. Dr. Hu came as a personal reference by a dear friend who had surgery by Dr. Hu two years ago and he is very satisfied with the outcome. I decided on robotic vs. open because I believe given equal and vast experience of the surgeons, the results will be better with robotic assisted. To hedge, I made an appointment with Dr. Wagner in Connecticut, just in case I didn't like Dr. Hu. Once I met Dr. Hu, I realized he would be my surgeon. I had surgery at Faulkner Hospital, which is very near Brigham, because Dr. Hu operated there two days per week and that provided me more flexibility on choosing a date, and also, the patient automatically stays in a private room, but at Brigham it would be a double. The staff at Faulkner was superb. Previous to this episode, I had never stayed in a hospital overnight, so I wasn't sure what to expect. I had my first post-op PSA blood test on Friday and I now await the results. Incontenence has been surprisingly not a real problem. I only use one pad per day, just in case, but I really could get by without it. If I over Kegel during the day, I think that encourages a little dribble, but it's really not a big issue. The other one though, impotence, is still an unknown for me. So far, not much happening down there. Dr. Hu was not a big fan of viagra therapy. I brought up the subject and he said it'll take time and the research doesn't support the expense. That disappointed me because I know all about ADC and their cheap generic. BM's started on the 4th day after surgery and have not been a problem at all. I hope all of this helps. [email protected]

A few comments.

I think I was fortunate that I had robotic surgery. I had a chronically inflamed prostate when diagnosed with PCa. The condition, I believe, covered up an earlier diagnosis.

This condition meant the surgery was very bloody -- inflamed tissue bleeds profusely -- I lost as much blood as the typical open surgery. And open surgery would have been worse. My surgeon shudders when he thinks about it. I know, because my wife works for him. (No, she was not part of the procedure, just part of getting me in for an extra exam this year, thank God).

She was a big part of the decision process. First because she would suffer the consequences of a bad decision, too. And second, she had been a surgical nurse for over 25 years, all kinds, crannie, nuero, thoracic, ortho, uro, etc. She has been on the front line of technological innovations for years.

Older surgeons rely on touch and that is how they learned. If they got good at it that way, then they are good at it that way. They are like old-school pilots who flew by the seat of their pants and the feel of the joystick. One problem with any open surgery is "adhesions" where your innards get bumped around with the hands banging around and the organs and bowls stick together later. Adhesions are nasty complications.

The new surgeons grew up in the world of video games -- a lot like today's modern pilots who fly by wire, or robot pilots who are controlling the drone strikes in Afghanistan -- they are very visually oriented and touch has nothing to do with their skill sets.

She has me thinking"Sopwith Camel or FA-18?"

As for radiation. All the Mrs. had to do was ask me to recall the time when I was a kid and used my dad's propane torch as a flame thrower on plastic toy soldiers, "That's what happens to your prostate when they use radiation -- I've seen it over and over again." Your back up plans are limited. Then again if Elvis has left the building, then that might be a good first choice.

I live in Western Michigan. The senior surgeon at the clinic told me an ironic story. "I have patients come to me and say they want to go the Northwestern for their surgery and then come back home and have me handle the complications."

Think about that for a moment. It's a bit of a hand grenade.

TIME OF DAY COMMENT: Surgeons doing delicate surgery often prefer early times because it's quieter and the scheduling was consistent. Later in the day, times can get bumped and the surgeon is working overtime/second shift on YOU. Then again, one cardiac surgeon she knows preferred a bit later, after the jitters from his morning coffee wore off. Then there are the ortho guys who like doing the delicate work early when their hands are sensitive and haven't been worn down by the hip or knee replacements, which is more like carpentry. They reserve the heavy-duty work for later, "They're banging and sawing and it sounds like remodeling." How would you like to be doing something delicate with remodeling going on in the next room?

Anyway, I'm still new at this. Surgery 10 days ago. Catheter still in. Three erections in the last week that hurt with the catheter. My sphincter seems to be at war with the catheter. It's constantly contracting and seems like it wants to pull the catheter out. Weird feeling.

OBB

I had open surgery 3/09. Now 18 months later I am not only fully continent but also fully potent. This is thanks mostly to a great surgeon than the open procedure. Experience is key no matter the procedure.