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Medical Forum / Diseases and Disorders / Prostate Cancer / September 2004Why Shorter LRP Catheter Duration
In the past there has been some speculation here about why LRP patients have Folly catheters in place for less than a week while RRP and PRP patients have to endure it for a couple of weeks. I've wondered about it too. You would think that in both cases there is the same wound that has to heal. I found the following explanation here: http://abcnews.go.com/sections/living/Healthology/prostate_laparoscopic_healthol ogy.html?HEALTHAd=true "How do the recovery times for people going through open surgery and laparoscopic surgery compare? In terms of hospital stay, I would say it's comparable. Usually the laparoscopy patients stay overnight. With open surgery, it may be one or two days. As for the returning back to normal activities, it's much faster in laparoscopy. I would say the patient would be back to work after laparoscopic surgery within two to three weeks, and that's mainly because the catheter that drains the bladder is removed very early in laparoscopy compared to open surgery. In laparoscopic surgery, we remove the catheter three to five days after surgery, while in open surgery it takes two to three weeks. In open surgery, you can only aim at stitching the bladder and the urethra together after the prostate is removed because it is a difficult area to see well. In laparoscopy, with the magnified image, we can see clearly where we are putting the sutures. As a result, you can put in very precise stitches in a water-tight manner, so that you don't need the tissue to heal completely before you remove the catheter. " > In the past there has been some speculation here about why LRP patients have > Folly catheters in place for less than a week while RRP and PRP patients > have to endure it for a couple of weeks. I've wondered about it too. You > would think that in both cases there is the same wound that has to heal. I don't think you are right here. I had RP and had my cath for a week.  SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories That report is a best case senerio which isn't the real world. I had an LRP and after a week had a cystogram that showed some leakage and had to have the catheter another week. Ron "Your mileage may vary", as they say. Certainly the norm is as stated. I had just wondered about the reason for this and thought I'd share what I found out. JP > That report is a best case senerio which isn't the real world. I had an LRP > and after a week had a cystogram that showed some leakage and had to have > the catheter another week. > Ron I had the robotic LRP and my Dr. targets 1 week catheter for his patients. I was out of the hospital in less than 24 hours and did not require any additional blood during surgery. I was driving my bull dozer at 2 weeks and back to work at 3 weeks. He says, his patients are normally back on the golf course after 2 weeks. MrBill age at diagnosis 48 PSA 1.4 Gleason 3+3=6 T2a robotic RRP 12/15/03 PSA 4/2/04, 7/8/04 = <.1 no more pads: 8/15/04 age 49 > "Your mileage may vary", as they say. > [quoted text clipped - 10 lines] > > the catheter another week. > > Ron I had RPP and my Dr targets 1 week catheter. I was out of the hospital in slightly more than 24 hours. I had a 4" incision (compared to the 2" LRP incision + 2 smaller ones). I was back to normal in three weeks except for incontinence. Unless your DR. plays golf he has no idea what he's talking about when he discusses golf : ) My Uro said something similar. "I'd need a light pad for occassional spurts." At my 4 month visit, I told him I needed a full pad per 9 holes and couldn't hold anything in (BTW, I walk my rounds). When he acted surprised, I asked him if he played golf. No. I explained to him the severe stresses of the golf swing, especially the drive. Told him the force could actually twist my watch around -- facing the inside of my wrist. He ultimately agreed with my strategy of playing on an empty bladder in the morning since every drop is spurt out anyway. I DID check into RLRP but they wanted $10,000 more than my insurance covered. I decided that for a savings of $9980, I could stand a bit more pain which wasn't all that bad anyway. My 2 cents. > I had the robotic LRP and my Dr. targets 1 week catheter for his > patients. I was out of the hospital in less than 24 hours and did not [quoted text clipped - 26 lines] > > > the catheter another week. > > > Ron "In open surgery, you can only aim at stitching the bladder and the urethra together after the prostate is removed because it is a difficult area to see well. In laparoscopy, with the magnified image, we can see clearly where we are putting the sutures. As a result, you can put in very precise stitches in a water-tight manner, so that you don't need the tissue to heal completely before you remove the catheter." Does something not seem a little crazy here? If the magnification provided by the laparoscope results in a better anastomosis, why on earth would surgeons doing open surgery not either get out a laparoscope or some kind of super magniying glass so that they can do a better job? If a simple, readily available instrument gives a better result - why not use it? I suspect it is because surgeons trained in and doing the open technique refuse to acknowledge that LRP docs may get better anastomoses. And they will stick to that story even to the detriment of their patients. FWIW I had my catheter almost 3 weeks and I do not regret it because I was 90% continent w/i a couple of days. Bill Denton RP 2/12/02 Memphis Part of the problem has to do with magnification but there is also a difference in how much blood (and other fluids?) are in the field. > "In open surgery, you can only aim at stitching the bladder and the > urethra [quoted text clipped - 23 lines] > RP 2/12/02 > Memphis "Part of the problem has to do with magnification but there is also a difference in how much blood (and other fluids?) are in the field." You may be correct but the doctor mentioned only the magnification as the reason they get a better anastomosis. But magnification apparently also helps minimize blood loss: ". . . the magnification and the image you get is so precise that you can avoid blood vessels." Again, if that is a concern, why not use magnification in open surgery? Bill Denton RP 2/12/02 Memphis |
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