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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005Outpatient radical prostatectomy
I was visiting New Orleans a couple of weeks ago and caught a TV ad which I thought was for Outpatient robotic prostatectomy at Tulane University Hospital. I was flabbergasted to see this on TV. I verified it with Google when I got home. One article I found was http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 1458072&dopt=Abstract I see a number of hospitals where it is done. The first was apparently at Henry Ford Hospital in Detroit. http://www.henryfordhealth.org/116020.cfm Wow! Has this been discussed here? Gotta say there are some things that frighten the living sh.t out of me and one of those is that I am incontinent. A lady I know has little time left to live. Her neck is effectively broken due to bone cancer. She decided, some time back, that she couldn't live, as she put it, disfigured and wouldn't have a radical mastectomy. I thought she was crazy but you know I wouldn't want to live if I lost that control. That and a stroke really frighten me. The rest is just life. Oh and yeah, my mother had cancer so if cancer can be said to be in the family, I guess it is in mine. > Gotta say there are some things that frighten the living sh.t out of me > and one of those is that I am incontinent. I don't understand why having to wear funny underwear is THAT frightening. I.P. >> Gotta say there are some things that frighten the living sh.t out of me >> and one of those is that I am incontinent. > > I don't understand why having to wear funny underwear is THAT frightening. Each to their own oddities, I guess but incontinence and a stroke are things I couldn't stand! I wont get my prostate cut out. I am more likely than not to suffer cancer from all my prostate problems according to GPs and specialists. If it comes to that, I couldn't end my life peeing myself uncontrollably. I know it doesn't seem to happen to everyone but if sh.t is going to happen, it happens here for sure! >> I don't understand why having to wear funny underwear is THAT >> frightening. [quoted text clipped - 5 lines] > uncontrollably. I know it doesn't seem to happen to everyone but if sh.t > is going to happen, it happens here for sure! While it's all about preferences, realize that post-treatment urinary incontinence usually means we dribble a bit now and then. As long as we're not wearing pale cotton trousers and no pads, no one's going to notice . . . and that includes the patient. I've never yet "peed myself uncontrollably"; I just leak a few drops or a small squirt now and then, and usually am not even aware of it until I check my Depends. The exception is in the evening when my remaining valves seem so be tired, when I'm not so much leaking more as just FEELING it more. We're talking cc's and sub-cc's here, not cups or pints. Past my first couple of months post-op, my dribbling hasn't interfered with any aspect of my life. I'll be pissed -- literally -- if it never stops, but so far it's just a prolonged post-op thing that we believe will go away. The primary differences betwen the days I change my Depends only once and only because it's bath time and the days I fill five of them are 1) $2.00 and 2) 8-10 hours of very strenuous, mind-occupying work or play. I've had a hundred one-diaper days and maybe three 4-5-diaper days since immediately post-op, and some of ther former have been very physical. A pad or two would have gotten me through 60-80 days so far, but I'm not taking that chance yet. It's your choice, obviously, but base it on facts, not fears. The pertinent facts include a) likelihood and b) severity. You can get (a) from Partin and (b) from us, the literature, and incontinence websites. Those impacted my choice between RT and RP. Healthy urine contains no bacteria; healthy feces IS bacteria. Guess which makes us unpopular quicker when we're wearing it? Guess which sets us on fire with diaper rash quicker? Guess which is easier to clean up? Guess which mistake is less obvious to the rest of the room? Which is easier to fix with a quick change of pad or "side-loading" Velcro diapers in a stall? Is there a risk of stroke in this club? That's a new one on me, except that due just to age, with any surgery. But "outpatient RP", even lap? Considering the impact of undetected bleeding, I'm not volunteering for that one. I'll take my chances with a couple of days surrounded by flesh-eating bacteria, or, even robotic overworked nurses. And never forget that with PC, how we end our lives is up to each of us. I.P. >>> I don't understand why having to wear funny underwear is THAT >>> frightening. [quoted text clipped - 10 lines] > not wearing pale cotton trousers and no pads, no one's going to notice . . > . Unfortunately that isnt true. There's always a smell depending on how your pee is at the time. Sure, sometimes it wont be noticed by others but at every time, I would notice and I would feel less than my normal self as a result and that would be a bad effect, too. > and that includes the patient. I've never yet "peed myself > uncontrollably"; I just leak a few drops or a small squirt now and then, > and usually am not even aware of it until I check my Depends. The > exception is in the evening Yeah but that is something I couldnt do. I am not denigrating anyone else but that would make me feel less than I do now and believe me, self esteem is not a thing that is good, for me, as it is. > choice between RT and RP. Healthy urine contains no bacteria; healthy > feces No healthy urine would always have bacteria in it. You are filtering poisons and they have to contain bacteria. It takes a lot of care and money to have a bacteria free environment and I dont think any cup of piss lives up to that! :) > IS bacteria. Guess which makes us unpopular quicker when we're wearing it? > Guess which sets us on fire with diaper rash quicker? Guess which is > easier to clean up? Guess which mistake is less obvious to the rest of the > room? Which is easier to fix with a quick change of pad or "side-loading" > Velcro diapers in a stall? Guess what I dont ever want to face? > Is there a risk of stroke in this club? That's a new one on me, except > that due just to age, with any surgery. I didnt say that to mean it had anything at all to do with prostate - just that it is one of my 2 great fears - but the truth is that with any operation on internal organs there is always a chance of a clot no matter how remote. Clots can produce strokes. > But "outpatient RP", even lap? Considering the impact of undetected > bleeding, I'm not volunteering for that one. I'll take my chances with a > couple of days surrounded by flesh-eating bacteria, or, even robotic > overworked nurses. I have had blood in my urine before. Of course on those occasions I had ruptured a kidney playing Soccer. Self healed no problems, no drugs, no operations. Have had blood from everywhere, since. Not worth investigating, though. > And never forget that with PC, how we end our lives is up to each of us. > > I.P. True with any cancer if your relatives allow it. Luckily I have told most of mine where to go so I wont have to worry about that. My wife wont like it but she knows what I want and will allow it to be that way. I cant see the point, if I ever get to the stage of "3 months to live" of fighting it. I would try chemo but no operations. > healthy urine would always have bacteria in it That just isn't so. Urine is wonderfully sterile unless you are sick. Med. students often drink a cup as a dare. However, I agree that urine can have all kinds of smells - especially if you love asparagus as much as me :-). However, Depends do have odour absorbers/neutralisers built in - others here can comment on how well those work. Anyhow, rather than speculate or rely on our comments, why not buy a pack of Depends, pee on a few of them at different times and decide for yourself how long they take to become "whiffy"? Or even better, just wear some of them around the house, and, er, "use" them and see what the reality is. For a few bucks you will be much better informed. In the end, as with us all, you must choose the course that is right for you. I don't mean this at all in a nasty or sarcastic way, but it would be wise to research good hospices that will give adequate levels of pain relief, no matter what (or move to Oregon). And make a living will (after the Schiavo affair, we all owe it to our families to do that anyhow, no matter which side of the debate we are on). One of my sisters just told me that the hospital where my father spent his final few months dying of PCa "saved" him from an embolism a couple of months before he finally died. By that stage he would have greatly preferred to have been allowed to die. >> healthy urine would always have bacteria in it > > That just isn't so. Urine is wonderfully sterile unless you are sick. Errr no sorry that isnt the case. All urine has bacteria in it. You just cannot avoid it. > Med. students often drink a cup as a dare. However, I agree that urine They are idiots for many reasons, bacteria not withstanding, doing that! Eeeeww! ;-} > can have all kinds of smells - especially if you love asparagus as much > as me :-). However, Depends do have odour absorbers/neutralisers built > in - others here can comment on how well those work. Asparagus! Another "eeeewww!" ;-} > Anyhow, rather than speculate or rely on our comments, why not buy a > pack of Depends, pee on a few of them at different times and decide for > yourself how long they take to become "whiffy"? Or even better, just > wear some of them around the house, and, er, "use" them and see what > the reality is. For a few bucks you will be much better informed. Ever noted how there are some things in life that you can smell and identify no matter how well hidden? Urine, for me, is that thing. Must have been a thing from when I was under 3 years old. I remember being in the cot and waking up one morning and realising I had wet the bed and knowing I was going to get smacked again. Pulled all my bedding out and chucked it in the washing tub and tried to wash it as I remember. > In the end, as with us all, you must choose the course that is right > for you. I don't mean this at all in a nasty or sarcastic way, but it > would be wise to research good hospices that will give adequate levels > of pain relief, no matter what (or move to Oregon). And make a living Move to OREGON!?!? ;-} Sheesh I have to move half a world!? Damn! Easier to find a ledge and base jump! ;-} > will (after the Schiavo affair, we all owe it to our families to do > that anyhow, no matter which side of the debate we are on). One of my I have had a multitude of debilitating health problems for many years, one being my entire life. For many years from my late 30s I couldnt work and at stages could barely get out of bed. I am working again now because I moved to an area that is much better for my health and I was determined to make it back. Checkered employment history due to health meant I couldnt get a job so I created one. Believe me when I say I dont just sit down and wait to die. > sisters just told me that the hospital where my father spent his final > few months dying of PCa "saved" him from an embolism a couple of months > before he finally died. By that stage he would have greatly preferred > to have been allowed to die. I know what you meant. Someone I know is going through that right now - may have died over the weekend. You just have to know when NOT to turn up in a death watch situation and that was this weekend for that family. All well-stated, and apparently well thought-out and thus reduced to personal choices. A few comments: > There's always a smell depending on how your pee is at the time. Sure, > sometimes it wont be noticed by others but at every time, I would notice > and I would feel less than my normal self as a result and that would be a > bad effect, too. It's sort of like BO: If *I* (or my wife) can't smell it, it doesn't exist. ;-) I hear ya on the feeling less normal, but since the only alternative I've found yet -- letting it impact my life -- is unacceptable, I guess I'll just have to gross out a few good smellers (if I can't blame it on someone or something else). Certainly I tolerate wetter shorts while working in the yard than while at a nice restaurant, but I can't think of anything I'm not going to do just because I'm wearing funny underwear. But then I haven't quite figured how I'm going to manage Depends in the summer, when they ripen more quickly, sweat like crazy, and may be a logistics problem when I'm changing swim suits/wet suits at the beach. A quick flash of white buns doesn't bother me --- especially when they belong to a 20-something lady -- but when passersby get an eyeful of diaper, I'm not going to feel 40 any more. > Guess what I dont ever want to face? Now THAT'S a solid argument! >> And never forget that with PC, how we end our lives is up to each of us. > True with any cancer if your relatives allow it. Luckily I have told most > of mine where to go so I wont have to worry about that. My wife wont like > it but she knows what I want and will allow it to be that way. I'm 61. I quit kowtowing to blood relatives > 40 years ago, and my wife fully supports my evolving living will. > I cant see the point, if I ever get to the stage of "3 months to live" of > fighting it. I would try chemo but no operations. I agree. I hope to hell to do my best to "enjoy" those three months as best as I can, especially compared to spending 90 days making everyone's life miserable by fighting a battle I can't win to gain three additional days of . . . miserable fighting. Surely Blockbusters, Barnes & Noble, and a dozen restaurants can cater a helluva lively 90 days for EVERYBODY, right? And if I'm too sick/confused/drugged out to at least tolerate my "party", it's time for me to end the party. My relatives other than my wife will have zero say in that, personally or legally. It's my and her freaking life, and they're going to suffer my loss anyway (or why interfere), so what's a few days or weeks if it helps my transition? But I'd try one more thing before letting an unfounded fear stop me from doing something I needed badly: read some self-help books to see if I could get over my objection. Or maybe your objection isn't so much "fear" as simply a fully rational decision that you simply aren't willing to accept even a 0.1% risk risk of that stroke. I'm beginning to get that impression, and can understand it unless a prostatectomy becomes a) your only option and b) quite likely to add vigorous years to your life. I'd shoot for a win/win living will, signed by wife, lawyers, and hospital (and a mafia hit man if necessary): cut (if that's clearly my best option), and if I get a stroke so bad I can't fully communicate my wishes, do what it takes to end my life. It's not fair to ANYONE -- not me, not my wife, not my HMO, not that guy waiting for my corneas, not the nurse cleaning my sheets -- to pump fluids through my unresponsive carcass for weeks or months, or, for GOD'S sake, 17 years. Yup, folks . . . another long one. But no one made ya look, expressing my thoughts openly help me evaluate them, many of us will face these choices, and maybe one other person will benefit from reading my out-loud thinking -- whichEVER way it may tilt their own choices. I.P. >> I cant see the point, if I ever get to the stage of "3 months to live" of >> fighting it. I would try chemo but no operations. [quoted text clipped - 6 lines] > impression, and can understand it unless a prostatectomy becomes a) your > only option and b) quite likely to add vigorous years to your life. What sort of life in reality, though? If I have to keep wondering if I wet myself 24 hours a day, that would become my life's focus and the thing that changes any plans. Personally, I dont see that as a viable life. People wail and whinge because they cant give up taking illicit drugs and want to or cant quit smoking and want to or cant lose weight and want to. I never took illicit drugs because I couldnt see the point in doing it. I smoked for many years around a packet and a half a day and stopped from one day to the next and I was very overweight until I found out my diet was unbalanced so balanced it and have slowly been losing weight since. Lost around 15Kg in 7 months which isnt that much but I hadnt lost weight, save for pneumonia, in over 20 years so for me it IS something! I continue to lose it with sometimes a reversal of fortune of a kilo. I am not spending my life like one of those whingers who cant quit smoking etc crying that I cant control my pee (which, for me, is a real fear and I am NOT saying anybody else at ALL does that) if I ever get prostate cancer which is a high probability for me. I am just going to go out with what I came in with, in that regard at least. If I get condemned to eternal damnation for not trying to live without a prostate afterwards, so be it! ;-} (No, I am not being a religious zealot. I was being irreverent!) > I'd shoot for a win/win living will, signed by wife, lawyers, and hospital > (and a mafia hit man if necessary): cut (if that's clearly my best [quoted text clipped - 3 lines] > cleaning my sheets -- to pump fluids through my unresponsive carcass for > weeks or months, or, for GOD'S sake, 17 years. What is that old prayer again? God grant me the will to know the ill conceived from the Divine inspiration, Grant me the will to survive the desires of others with grace And grant me the lawyer to put my family in their place. ....something like that anyway. ;-} > Yup, folks . . . another long one. But no one made ya look, expressing my > thoughts openly help me evaluate them, many of us will face these choices, > and maybe one other person will benefit from reading my out-loud > thinking -- whichEVER way it may tilt their own choices. Ahh you have hit upon another subject that I only discovered in the last 5 years or so. I put in an email to someone who has really annoyed the hell out of me exactly what I think and then I read it and don't send it. If I can read how I really feel as typed by me, I get over it easier. I don't know why.....just happens to be that way for me. I think it helps me clarify things which churn under the surface and give me gastric reflux if I do that. So far, my heartburn is a lot better! ;-} I've never heard of RP causing 24/7 incontinence. I.P. "Coilman" <hahaha@no.way.fool> wrote > > What sort of life in reality, though? If I have to keep wondering if I wet > myself 24 hours a day, that would become my life's focus and the thing > that changes any plans. Personally, I dont see that as a viable life. Nope. There has been very little discussion here of radical perineal prostatectomy at all, never mind radical perineal prostatectomy performed on an outpatient basis. >I was visiting New Orleans a couple of weeks ago and caught a TV ad which I >thought was for Outpatient robotic prostatectomy at Tulane University [quoted text clipped - 7 lines] > > Wow! Has this been discussed here? When I was diagnosed they told me that the RP could be done one of two ways, the perineal and the retropubic approach. The doctor did not indicate at any point that he was seriously considering the perineal alternative though. They did, however, give me instruction on how both are done. I wonder if there is any advantage to the perineal approach? As to outpatient, a few years ago when Medicare went to a new reimbursement system for outpatient services they published a list of procedures that they would not pay on an outpatient basis. One procedure on the list was masectomy. Can you believe that they would do that outpatient? > Nope. There has been very little discussion here of radical perineal > prostatectomy at all, never mind radical perineal prostatectomy performed on > an outpatient basis. The advantage of perineal is with extremely obese patients, in which surgeons must work in too deep a pit to get at an RRP. Its primary disadvantage, if I recall correctly, is that is doesn't provide lymph node access. I.P. > I wonder if > there is any advantage to the perineal approach? > The advantage of perineal is with extremely obese patients, in which > surgeons must work in too deep a pit to get at an RRP. Its primary > disadvantage, if I recall correctly, is that is doesn't provide lymph node > access. Historical note: The first known prostatectomy was performed by Dr. George Goodfellow in Tucson, Arizona in 1891. It was a perineal. The first paper on the subject was published by Hugh Young, urologist at Johns Hopkins, in 1904. The first retropubic RP was reported in 1947 by English doctor Terrence Millin. See: http://www.prostate-cancer.org/education/localdis/brosman_RP2003.html I hadn't heard that obesity was a reason for resort to perineal RP. I doubt that that was the case between 1891 and 1947, though. Regards, Steve J See Walsh, pp 220, 221, 238, and 239 (plus Google) for the pros and cons of perineal prostatectomy, including obesity. I.P. > I hadn't heard that obesity was a reason for resort to perineal RP. Also this: http://www.marinurology.com/articles/cap/jurol-1997.htm and other material on that site. I considered these guys before swinging towards the trip down to LA for the DaVinci machine (their numbers are better). Seems like a good surgeon can do it any way they want with good outcome. A less-good surgeon may well screw you up no matter what.  SignaturePeter Headland I forgot to pint out that these guys claim to have good rates of nerve sparing despite going transperineal. At the very least it disproves that transperineal and nerve sparing are mutually exclusive. SignaturePeter Headland There is a wide selection of different treatments for prostate cancer from surgery to radiation seed implants. Mine was a personal choice after I got all the facts. Dr. Patrick Walsh, in his "Guide to Surviving Prostate Cancer", also known here as "the bible" makes that same point. Finding the best surgeon is paramount if you want to have sex and hold your pee when it's all over. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Also this: http://www.marinurology.com/articles/cap/jurol-1997.htm and > other material on that site. I considered these guys before swinging [quoted text clipped - 3 lines] > Seems like a good surgeon can do it any way they want with good > outcome. A less-good surgeon may well screw you up no matter what. > When I was diagnosed they told me that the RP could be done one of two ways, > the perineal and the retropubic approach. The doctor did not indicate at > any point that he was seriously considering the perineal alternative though. > They did, however, give me instruction on how both are done. I wonder if > there is any advantage to the perineal approach? The means whereby the prostate is removed depends on many things, perhaps your doctor considered them and recommended the one best suited in your case. Yes, there are advantages (of a sort) to perineal prostatectomy. It's more easily done, there's less risk of infection,virtually no blood loss, and your recovery time is minimal. The most significant advantage to retropubic prostatectomy is that with this procedure it is possible (unless the disease is highly advanced) to spare the nerves surrounding the prostate. This is important if you are still sexually active and desire to be after the surgery is over. Of course, if your PSA is high, oh, say, >30, the damage to the prostate has already been done and you have probably experienced impotence already. In this case perineal prostatectomy would almost certainly be called for. I'm not a doctor; I speak only from personal experience. My PSA was 28+ four years ago and I underwent the perineal route, the one recommended by my urologist. He didn't even suggest the alternative. Recently this doctor has begun to treat patients with cryosurgery and I asked him about it this morning. (I had a PSA checkup which, thankfully, is still holding at <0.1.) He recommended this method for men who had great fear of surgery and/or radiation. Of course, it's still much too early for him to compare the effectiveness of freezing vs. removal. Talk to your doctor. HTH Ken Bland I don't think so. I've never heard of it. jimhoney standard RRP age 52, cured, no significant aftereffects > I was visiting New Orleans a couple of weeks ago and caught a TV ad which I > thought was for Outpatient robotic prostatectomy at Tulane University [quoted text clipped - 7 lines] > > Wow! Has this been discussed here? I'm not at all surprised at out patient RP. I had the Robotic job Feb 2004, and felt well enough to go home that night. The doctor wanted me to stay just in case something went wrong. I would have gotten a lot more sleep. Steve U > I was visiting New Orleans a couple of weeks ago and caught a TV ad which I > thought was for Outpatient robotic prostatectomy at Tulane University > Hospital. I was flabbergasted to see this on TV. > > I verified it with Google when I got home. One article I found was http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 1458072&dopt=Abstract > I see a number of hospitals where it is done. The first was apparently at > Henry Ford Hospital in Detroit. http://www.henryfordhealth.org/116020.cfm > > Wow! Has this been discussed here? I agree that it is conceivable to undergo LRP and not have to overnight in hospital but the article is about perineal RP, not laparoscopic RP - which is what makes it surprising. > I'm not at all surprised at out patient RP. I had the Robotic job Feb > 2004, and felt well enough to go home that night. The doctor wanted me [quoted text clipped - 18 lines] >> >> Wow! Has this been discussed here? |
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