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Recovery after Da vinci surgery

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Posted 6/25/2011 5:28 PM (GMT 0)
I am a concerned girlfriend, my boyfriend is 62 and has scheduled surgery for July, Da vinici method.  He is very active and we are lucky to have a wonderful sex life.  I am 15 years younger and he seems afraid of the recovery after surgery.  Does anyone have any advice, we are both concerned about impotenence and incontenance. 
Posted 6/25/2011 6:13 PM (GMT 0)
Thompsongirl,

First, a welcome to Healing Well. You'll find a lot of partners here as well as those of us "on the other side" (had surgery).

I think you will get as many different answers as people who respond.

I'm copying some comments on books from previous posts - you may want to see if you can find these at a local library, or check your favorite bookstore.

"Guide to surviving Prostate Cancer" by Dr. Patrick Walsh, 2nd edition (2007), pretty much considered the "textbook" by many of us.

I've read both, and find Scardino's book a good alternative. In the new edition there are more useful diagrams, and some areas that I though were vague in the older edition are improved. Also, being a 2010 edition, some of the factual details are more up to date.

Walsh is more brutally clear on some points.

For the more specific subject of sexual questions, you might look for "Saving Your Sex Life, A Guide for Men With Prostate Cancer" (2010) by John P. Mulhall, MD (he is from MSK Cancer Center, and has several on-line videos about sexual function rehab.

I can't be of much help, as I had non-nerve sparing surgery, and am not yet to the point of experimenting with shots or considering surgical "changes".

Partly because my PCa was very advanced at the time it was found, I have more incontinence issues than many others here, so will not be a model there, either.

You may want to tell us more about the biopsy results, as the extent and Gleason scores are what tell us most about his cancer.

Posted 6/25/2011 6:21 PM (GMT 0)
Thank you so much. We do have the "Guide to survving Prostate Cancer", I will get the other ones as well. Will get information on biopsy and Gleason scores.
thompsongirl.
Posted 6/25/2011 6:38 PM (GMT 0)
Welcome, here's a link to a 4 part video from one of the 'experts' in the field. I would also mention that this is an individual disease, with individual reactions to each step of the way, so my or someone else telling you what we expereinced may and probably will not apply to his situation.

www.mskcc.org/mskcc/html/94910.cfm

If you like to read it instead, here's a thorough, well written paper on the subject.

www.clevelandclinic.org/ReproductiveResearchCenter/docs/agradoc196.pdf

Anything further?, feel free to ask... blush
Posted 6/25/2011 6:56 PM (GMT 0)
Dear Thompson Girl:

Welcome to HW but I'm sorry you have to be here.  As others have said, when you provide more info re biopsy pathology, some folks here can probably provide you with remarks more specific to your BF's situation. 

Quality of life results vary dramatically by individual and by doctor.  There are many men who are members of this forum who have had an excellent recovery from surgery with respect to both urinary and sexual issues.  And, there are also many who have had problems - some of them significant.  Depending on the diagnosis, there may be options to surgery that provide potentially better quality of life.  In doing your due diligence on treatment you owe it to yourselves to study multiple options for treatment until you find the one with which you are most comfortable.  However, one variable stands out no matter which treatment you choose...please make sure to find a doctor who is experienced in your treatment of choice.  There are studies that indicate better curative and QOL outcomes from doctors with 250+ surgeries completed.  I'm confident this hold true for radiation treatments as well.

Good luck and please keep us posted.

Tudpock (Jim)

Posted 6/25/2011 7:20 PM (GMT 0)
Thanks Jim,
Good to know, he is having it done at City of Hope near Los angeles, will pass on the information to him and have him post his numbers. :)
Lisa (thompsongirl)
Posted 6/25/2011 8:15 PM (GMT 0)
Lisa,

James C.'s link for the videos from MSK is the same as I mentioned but did not have at hand. They are presented by Mulhall. A long, dreary listen, but all valuable information.

The "find an experienced doctor" advice is more important than ever in the area of Prostate cancer, as it is so unique from patient to patient.

Posted 6/25/2011 11:20 PM (GMT 0)
If your sex life is really important, you might want to consider seeds plus IMRT as the primary treatment...You gave no details concerning his biopsy results, PSA, Gleason score, number of positive cores, that sort of stuff, but surgery is a 50-50 deal when it comes to impotence, nerve sparing or not..Much better odds with Brachytherapy plus beam radiation and it seems a better cure rate..You should investigate ALL your options before committing to surgery...
Posted 6/25/2011 11:50 PM (GMT 0)
A few thoughts include how much testing he has for any treatment as well as second opinions. Dr. Duke Bahn, near LA., may be a choice to add to his prognosis. I have read great things about him.

Am glad that you found this thread because all here have been very helpful to me. Good folks here!

Posted 6/26/2011 4:15 AM (GMT 0)
There are a lot of variables. I had the di vinci and was back at work (sedentary) in a week with no incontinence and no impotence. It is possible. Think positive.
Posted 6/26/2011 5:00 AM (GMT 0)
Thompsongirl,

The City of Hope has a number of excellent robotic surgeons and I almost went there myself. However, he should look at other options before deciding on surgery.

Good luck.
Posted 6/26/2011 10:20 PM (GMT 0)

As someone said, you will get a wide range of answers.  I am 70 years old and in pretty good shape, both my partner and I are very motivated when it comes to sex.  I have never had a natural erection or one with pills since my surgery, but I get 100% erection success with bimix injections.  We have "sexual encounters" at least twice a week. tongue   While it is different with a dry orgasm, it is still pretty darn good.  I, of course, would like things to be as they were pre surgery, but they are not..life changes.

My urologist told me from the start that a high percentage of men have erectile difficulty after surgery.  He also said that if I was motivated he would help me find a way to make it happen.  I do not know if men get better erections after brachytherapy or radiation than surgery.  Statistically they do, however I have talked to several men who admitted that after brachytherapy they were disappointed with the results and it got worse over time.

Everyone seems to have a different story.

Posted 6/27/2011 12:18 PM (GMT 0)
I don't want to sound negative or be a downer, be even under the best conditions after surgery, your sex life will be dramaticly different from what it is today, and you will have to adjust and learn to accept a lot of things different.

I speak from first hand experience.  I am 60 now  and prior to surgery 4 years ago, my wife and I had a very intense sex life, but surgery changed all that.  I was very "lucky" in the fact I choose a good surgeon for my surgery, and I have no ED issues to deal with after my surgery.  I can achieve rock solid erections without taking any drugs and they will last for hours if needed.  But the the problem I do have to deal with is sexual incontinence. 

I am dry at all other times, but as soon as I start getting sexually aroused, I feel my splinkter muscle relax and I will start dripping every where uncontrolably.  No matter if I empty my bladder before sex, I will still drip like a open faucet.  You just don't relize what a damper that puts on sex.  Now ,   before I have sex, I have to lay towels everywhere so I don't drip on the bed.  Worst than that, I have to be super carefull that  I don't drip all over my wife. You just have no idea how that changes intimacy from spontaneous love to planned sex.  Its not fun anymore.

Orgasms are another whole ordeal. Now, after my surgery, I ejeculate urine instead of seman.  My uro tells me that urine is steril and if you shoot into your partner it will not hurt her. Yea, just try telling that to a woman.  My wife is very understanding, but even she gets grossed out when she thinks about having urine shot in her. Wearing a condom does not help because I loose all sensation and then my erection dies.

Also, because I drip urine every , any oral stimulation is completely out of the question.   

I am telling you all this to let you know what to prepare yourself for at the worst case.  Each person responds differently to surgery, so your boyfriend might not have any of the problems I have, but  just be prepared for changes, because sex will not be the same after surgery.


Post Edited (NY-Sooner) : 6/27/2011 7:02:25 AM (GMT-6)

Posted 6/28/2011 4:49 PM (GMT 0)
Thank you to all for all the great information.  I understand that there will be changes in our sex life, and am ok with that.  Even the possibility of urine dripping does not bother me.  The videos of Dr. Mulhall were very informative and helpful.  He suggests starting ED drugs before surgery, that one was new information.  Did anyone do that?  The doctor he has at city of hope has done about 3,000 surgeries, so that is reasurring.  They also suggested he have a colonoscopy before surgery.  His last one was about 4 years ago and normal.  His PSA is 7 and so is his Gleason, and he had his biopsy results sent to John Hopkins to confirm it is cancer.  Will keep you posted...

Thanks so much!!

Lisa

Posted 6/28/2011 6:55 PM (GMT 0)
Lisa,

My uro did not start me on ED meds until a couple of months after surgery, but many have posted that they started very soon after the catheter was out. It makes sense, as the meds are first intended to improve and maintain blood circulation in that area. Also, there may be a bit of work to do with the insurance company, so it makes sense as well to get the process started. Most US insurance company have very limited allowances for the quantity/strength they will cover (this sends many here to ADC in India for cheaper prices, but that is in theory illegal). You need to investigate what they cover, how much they reimburse, and what alternatives for appeal they may have.

Also, starting to get some samples from the Uro (and try your GP as well), and testing to see if they work or have unwanted side effects will resolve some questions early on. For example, I don't tolerate Viagra, but can take Cialis.

Yet more information to work your way through smilewinkgrin

Posted 6/29/2011 6:52 PM (GMT 0)
 

Its been a couple of months since my husband had the robotic and we are only focused on the incontinence right now.  Its getting better, but still he is incontinent and has to wear depends and guards.  It may not happen to your husband...but it might.  I think once the incontinence is out of the way, you can focus on the sex.  Right now, we are not even interested in discussing sex. 

Posted 6/30/2011 8:07 PM (GMT 0)
As you can tell - post operative experience of and reaction to incontinence and impotence vary widely. My main suggestion is communication. Remember that the most important sex organ is the brain and that is what you need to focus on.

For me and my wife the hardest thing was that I had to learn to talk much more. Before ED she could judge my state of excitement physically. Now I need to provide a continuing commentary about my feelings. "Yes, that feels good to me even if you don't notice a physical response." This is an ongoing effort -- I need to describe and she needs to question.But in an odd way it is a closer form of sex because we are joined at the mind rather than just at the groin.
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