how much can we trust our surgeon ?

we are in their 'capable' hands;  if they tell us they saved both bundles of nerves (but only when specifically pressed on the subject) during a, weekend early morning, delicate robotic operation following a possible boozy dinner party the night before, do we beleive them ?   

ok, sorry if i sound bitter, but when, with each post op visit, you are told the time for effective nerve re-growth has amazingly been extended by yet another 6 months, you DO begin to doubt their integrity.....how do we KNOW for sure just how much nerve sparing went on during the op ? 

18 months on, and no sign of nerve reconnection, except possibly ! ?  ......   has anyone else experienced a mild process of penile engorgement after going to the toilet (sitting down i mean)  what does this mean...have the nerves grown the wrong way, or was the surgeon just having a bit of fun    oh you can hear the banter at the repeat dinner party...."last time , you were about to perform a big operation on some poor sod's prostate,,how did it go ?"..."well, just for a laugh i reconnected his nerves in such a way that the only time he'll acheive an erection is when he goes to the toilet.

ok, we must have respect for these brilliant people, but , how much can we trust them, how will we ever know the truth

Probably the best early sign of returning function is any engorgement when you first wake up in the morning. This has long (going back at least to Kinsey) been a gauge of male erectile potential.

A prostectomy is a major operation that is going to traumatize the nerves and at the time it is impossible to tell the extent of the trauma. Nerve sparing just means that the nerves were not cut and thus hope remains of slow regeneration.

I still like and highly respect my uro/surgeon. Even though I have been plagued with a lot of negative issues, I don't blame it on poor surgery. I blame it on my own body, my own past medical history, and complexities that had nothing to do with surgeons skill or lack of skill.

Mine was the opposite situation. I was told from the start that it was non-nerve sparing because of the amount of PC, PSA number and velocity, etc. In the end, the left bundle was indeed severed completely, as all the cancer was found on the left side, and the right side bundle was not removed, because of having a deep and narrorw prostate bed, making for a complicated surgery. The right side was noted as being damaged. Having said that, I experienced absolutely no ED problems. Was able to have full errections and orgasms 63 days after surgery, which was when the last of the original catheters were removed. Yes, I know it makes no sense.

I wonder, not accusing, sometimes just how much work is really put into the nerve-sparing specific surgeries, and how subjective is that from the surgeons perspective? When you look at the variety of ED issues just here at HW, its not very convincing that the nerve sparing ops produce any more ED free or ED easier recoveries. I know we are just seeing a small batch of men here. Also, and this may not make me popular, but I am still not convinced that robotic surgeries have any improvement in either ED or incontinence. Again, thats based on limited data. Just a thought.

Our surgeries, open or robotic, are incredibly complex surgeries, one of the most complicated. And each man's body and medical history and even geneticis make a lot of difference. Don't think there are too many blotch ops because the surgeon had a drink the night before, not buying into that line of thinking.

David in SC

You may not of heard of malpractice suits. The last thing you would want as a doctor is a full length video.

I asked my doctor. He said they couldn't do it. yeah right !

I was given without being asked, full color pictures of my first corrective surgery after my big surgery for the scarring in the bladder neck, didnt do any good, lol, as it blocked over 3 more times after that.

I was told after my surgery that one bundle was removed because it felt a little bit hard but I have had no ED problems at all infact she made a comment last time the sex was as good as before my operation I feel the same has David that I am not convinced of the advantages for incontinence and ED between Robotic and open surgery

Jeff,
great idea on paper but the problem with such a system of grading is that there are quite a few surgeons who will not operate on Gleason 8 and 4+3=7s. Operating exclusively on low volume G6s will yield some pretty impressive but misleading statistics. On the numbers front if a doc watches 50 robotics, open and closes another 50, does 50 more under supervision and instruction and then gets his first solo patient can he claim to have done 150 robotic surgeries.
Bill

Post Edited (BillyMac) : 11/9/2009 9:45:05 PM (GMT-7)

I gave my doctor my priorities in this order of importance.
1. Eradication of all cancer
2. Preservation of continence
3. Preservation of sexual function at some point
He simply said that the priorities he had were the same and in that order. He told me ahead of time to forget about the right nerve because it was going for sure. He told me after the same thing.
Every doctor has to read and sign his op reports no matter who dictates them. Believe me no doctor ever wants to be on the witness stand and have some smart lawyer ask him, "Doctor, don't you read what you sign?" To change or omit from a medical record is just plain stupid.
When you are dealing with some men's "manhood", be prepared for a group of unhappy guys who can lose sight of the original problem. A stiff penis is little comfort in a coffin (I would think).
A well known Mayo Clinic surgeon was once known as the man who had operated on more of a certain brain tumor than anyone in the world. he merely strolled from one room to another, did his thing, and let others open and close. Would I have let this man operate on me? Not likely!

Are we getting to the "How many angels can stand on the head of a pin" point? The operating surgeon is listed on the OR record and should get the credit for the procedure. "Ghost surgery" is deeply frowned upon in all US hospitals and could cause the loss of privileges.

I too took the decision based on the cancer incontinence erection list of priorities. I was told they would try and do nerve sparing. I was told afterwrads that they had. I got my first semi erections before the catheter was out. I thus have the erections, am getting on top of the incontinece and hope that the PCa itself will also be seen to have been beaten when I get a PSA test result next week Yes I trusted my surgeon, and I'm not saying that becauue there are so many surgeons and doctors in my family, the surgeon adn the whole medical team really seemed to be taking me with them. So I think there must be many factors here in addition to how good the surgeon is. And the main one may simply be our anatomy. Our prostates (and the space in our pelvises where they sit) are just as much a part of our anatomy as our noses or penises and as such will also come in all shapes and sizes as will the nerves. So what the operation has to remove and what it can leave behind will be determined by what is there. And the surgeon only finds out those details when he starts snipping. I understood that the nerve-sparing part of the surgery was something like peeling an orange and then trying to remove the edible part while leaving the white pith behind. The nerves are thus a web or network of very fine threads rather than one thick cable like structure and the surgery may merely spare some of the web while removing part of it, and what is left may be nerves, but may not include the right bits or enough of them. The nerves that are left may also get damaged by the operation and this is where all that vagueness creeps in about how long it will take for them to recover or regrow. We have to acknowledge that Prostate Surgery, like prostate treatments and cancer treaments in general have not yet reached the point where they will end up and that we are just at a point on that journey where we are getting a better deal that the previous generation and those that come after us will in their turn get a better deal than us. And we could not really decide to sit around for too long, if at all, for any such better treatements to come along. After all the concept of "Nerve-sparing" is in any case a relatively new one. Alfred   

wesd40,

The Dr you need to trust with your life is not the Urologist doing the surgery, its the anesthesiologist that has to make sure you wake up

 

Yes I trusted my surgeon with my life, so what do I say about the anaethetist.

I had had a pre-op check-up with an anaethetist, and he was very serious, and pointed out that with 12 of them at the hospital I would simply get the person who was on duty that morning. The guy who turned out to be on duty had a very good bedside manner, and given I was okay during the operation (as far as I know) I assume he did a good job too. All I can really tell you about him is this.

I had been prepared by assorted nurses and then the anaethetist appeared beside me and said he was going to inject me with some stuff that would make me feel woozy etc, (propofol I think) And then added with a grin that it was exactly the same stuff that the newspapers were reporting had been given to Michael Jackson a couple of weeks earlier. And that kind of brokem the ice. He was great. I was still chatting away to him many minutes later when I went out.

I guess another person that you need to trust is the one with the razor who shaves you! (I shaved myself the day before!)

Alfred

 

Didn't Reagan say: "Trust, but verify." ?
Cameras should be required with any complex procedure taking more than 1 hour and costing more than $1000. We require video cameras on every police car to verify the officer's and perpetrator's actions. There are cameras on cashiers both to record potential crimes and errors. Every ATM has one. I'm willing to bet every DaVinci machine has 1 or 2 also.
The surgeon is preforming a life death dance with your privates. Why is it too much to ask for a picture? If a 7-11 clerk can be recorded all day long, certainly the surgery could be.
If there's nothing to hide there should be no objections. Would it make lawsuits too easy? Or would the cameras show perfect performance and squash them?
If cockpit cameras were rolling would the Northwest pilots be flying the plane instead of playing Grand Theft Auto III on their pcs?
Just askin'
Jeff