Prostate Diaries Search Question:Why do I have to wait three months after prostate biopsy to have a prostatectomy? Think….Denonvillier’s and a surgeon adverse to risk.


how much was Hunt worth when he died? nothing

Charles-Pierre Denonvilliers

  • When a urologist does a prostate biospy, a ultrasound probe goes into the rectum much like a finger does to examine the prostate.
  • So when a doctor examines the prostate he is feeling the prostate through the rectal mucosa.
  • So when the biopsy is performed, the needle goes from the ultrasound probe, through the rectal mucosa and then into the prostate.
  • Needles into organs, and tissues etc for some reason are very well tolerated by the human body, hence biopsies being done with consequence….usually…..I had to admit a gentleman this week for hematuria after a prostate biopsy. The first time in almost a year. He’d been on aspirin, which he’d stopped for a week, and that apparently was not long enough.
  • So “Doc, I just had a colonoscopy, didn’t that check my prostate?” I think….”Good try my good fellow, but that ain’t gettin you off the hook for a rectal exam.” ” No sir…that sees the rectal mucosa that covers the prostate. It doesn’t see or feel or examine the prostate. Just the rectal mucosa. Different organ, different system, different kind of doctor, different instrument….unrelated but very good try.”
  • So, the needle goes through the dirty ole rectum, through its mucosa, through the space (in and about Denonvilliers), and then into the prostate and then back out before the small specimen is deposited into the formalin.
  • This is repeated usually twelve times…some times more depending on the number of biopsies the urologist has elected to do.
  • Well…maybe 5% of the time the body will get an  infection  from this. Usually a bladder infection, particularly if the patient has some underlying prostate symptoms, but sometimes bacteria from the rectum gets into the blood stream (bacteremia) and this is a  medical emergency of sorts and often requires admission and I.V. antibiotics.
  • More commonly, secondary to the trauma to the area and the “spaces that separate the prostate and the rectum” there is an inflammatory response of the body to “heal” the area after the biopsy. This inflammation response varies and can be minimal or dramatic.
  • This in turn affects the tissue plane  between the rectum (we don’t like hearing talk of rectum when removing a prostate) and the prostate.
  • Surgeons love pristine undisturbed tissue planes. (That is why you don’t often of urologist removing a prostate after radiation. It messes up that tissue plane related to Denonvilliers and wreck havoc on the dissection and increases the likelihood of “dissecting into the rectum” a surgical nightmare.
  • We speak of not having a tissue plane as scarred, adherent, or “dissecting through concrete.”
  • It is very deflating to a surgeon to have a patient under anesthesia and it is determined that the dissection will be difficult because of the above. A one hour procedure can  turn into a three-hour one, and with increased chances of complications.
  • So…back to the question ….’Why do I have to wait 6 wks to 3 months to have my prostate out?”
  • Because we are waiting for the inflammatory response of the body in and about Denonvilliers fasia to subside and make our job easier to remove the prostate.
  • Since prostate cancer is a “slow-growing ” cancer usually….the time delay  is of no medical consequence.
  • The diagrams below show the space and how it is possible that in  removing the prostate one could get into the “wrong space” particularly if it is adherent, and then enter the rectum. That is bad, because all the bacteria in the rectum is now in the area of prostate. Man what a mess. Knock on wood….this has not happened to me….yet.

And this (the above) is just one of the things going through the heads of your caregivers while they are trying to help you  navigate the prostate cancer decision-making process. And why I say the “surfing the net” and making “goining it alone” decision doesn’t offer the  depth of texture necessary for a decision customized to you.

My advice…sap everybody and everything with a discerning eye before your “Decision.”

 

Denonvilliers fascia

 

 

The "dissection plane" between the prostate and rectum-trust me-you don't want to "get into the rectum"
The two arrows show a space and "tissue plane" that seperates the prostate from the rectum.

2 Replies to “Prostate Diaries Search Question:Why do I have to wait three months after prostate biopsy to have a prostatectomy? Think….Denonvillier’s and a surgeon adverse to risk.”

  1. Nice post Dr. McHugh. I think this plane was difficult for my surgeon and I’m wondering if it might be related to my erectile nerves still sleeping at 8 months post op. Both were spared. It took 4 hours with the robot instead of his normal 1.5 hrs.

    BTW, how do you make those nice drawings?

    Like

  2. hi, i enjoyed looking at your site….i’ll look you up for a tour when i am that way….maybe… i am mild/moderate clostraphobic….
    most of my drawings are from my book…adobe illustrator…
    the ones today are from a bju article about infections of the denonvilliers fascia after biopsy. in essence i “lifted them”
    i plan to do a post on “my nerves were spared.” in my opinon a surgeon, open or robotic, can’t say they spared the nerves. they can say they stayed away from and were pleased with respect to the nerves and the dissection, but to say with certainty that “I spared your nerves” is a bit of a misnomer or such. I’d be interested in anyone’s take on this. having performed several hundred prostatectomies and using the walsh technique, i can say from an open perspective you don’t see the nerves. i don’t believe with the robot you “see” them either.
    a great sign about your return of erections is that if you take a viagra you get some fullness. if you get even a bit of fullness with meds, you probably will be ok. my complete return to normal was 18 months, but i had success with meds early on….
    loved your website and the pics of arizona….kind of made me homesick for out there. i pack packed for a week for 15 years in that area and it brought all that back. jm ps apologize for no caps, and spelling but the response doesn’t give me the spell check options that the posts do and i am anxious to finish cutting grass with my dogs at the lake…….

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s