Incontinence after prostate cancer treatment-Is the open method better than the robotic?

i keep telling myself....he that seeks revenge should dig two graves.....
i keep telling myself….he that seeks revenge should dig two graves…..

So I had my prostate remove for prostate cancer in 2007. And I have in one of my bathroom drawers ticket stubs from the the Braves World Series Games from back in 1991. (Man what a year for Atlanta-I went to every Atlanta home game and dammit we should have won it….Remember Terry Pendleton and Lonnie Smith and the whole second base debacle where the guy pretended he was receiving a throw for a double play when in actuality the ball was on its way to the left field fence)

The first World Series Game 7 in four seasons saw a rematch of the Game 4 starters. Jack Morris returned to the mound for his third start of the Series for the Twins while John Smoltz made his second for the Braves. Going into the game, this Series had been regarded as one of the best ever. The seventh game would reinforce that point.

Neither team was able to score a run early on. The Twins had their first opportunity in the bottom of the third inning, when Dan Gladden doubled and advanced to third on a flyout by Chuck Knoblauch. But Smoltz struck out Puckett to end the inning. The Braves put a runner into scoring position with one out in the top of the fifth, as Mark Lemke reached third on a sacrifice bunt by Rafael Belliard and a bunt single by Lonnie Smith. But Morris got Terry Pendleton to pop out and then struck out Ron Gant to end the threat.

Neither team threatened again until the eighth inning. The top of the inning included a critical defensive play, with Smith on first and nobody out. Braves manager Bobby Cox called for a hit and run with Pendleton at the plate. Pendleton responded by lacing a double into the left-center field gap, but Smith only advanced to third. Logically, Smith could have scored on the play, but after Pendleton made contact, Twins infielders Greg Gagne (shortstop) and Knoblauch (second base) feigned starting a double play by pretending to force out Smith at second. Smith hesitated, then ran to third as Pendleton headed for second. Smith claimed he hadn’t been fooled by the decoy and was waiting to see if Puckett or Gladden would catch the ball.

Anyway I am looking for some eye contacts the other day and see this envelope with my name on it – like a patient information sticker we use at the hospital. I open the envelope and there is this picture you see above. Then it dawns on me that it is a picture of my insides after the prostate had been removed. What you are seeing is the bed of the prostate and a catheter coming out of the urethra. I got a bit nauseated seeing the picture and thinking about the surgery and that that was me. It gave me the hibbi gebbies.

The next step in the surgery would have been to then sew the urethra to the bladder. In a robotic removal the anastamosis is intraperitoneal and is supposed to be water tight. In an open prostatectomy the anastamosis is extraperitoneal and requires only 4 stitches and that the urethra and bladder neck be aligned correctly over the catheter.

So the anastamosis is different for the two procedures. I leaked for 3 months and the last 8 open prostatectomies I performed only one leaked at all post op and that cleared in 2 weeks.

So….Is the difference in incontinence time and rates of the two procedures related to the intra vs extra peritoneal anastamosis? I don’t know and it really doesn’t matter. The open prostatectomy is a dinosaur which is dying on the vine.

And it’s a shame too, because I had gotten very good at performing them and the patients did well.  Video killed the radio star and the robot killed the open prostatectomy star.

4 Replies to “Incontinence after prostate cancer treatment-Is the open method better than the robotic?”

  1. “…because I had gotten very good at performing them and the patients did well.” And undoubtedly you were excellent after many years in practice and many practice runs. Which really gets to the heart of the matter which is this: Difficult and complicated procedures simply take quite a while to master in every field, and generally speaking that mastery is only obtained on human patients, all of whom expect a perfect result every time.

    Yet I’m not sure the average patient realizes that the training to become a master surgeon is ongoing — especially when procedures are very difficult as is both open and robotic prostate surgery — even after one has been in practice many years. Practicing surgeons in every field cannot simply tell their patients they are getting comfortable with a given procedure and then say “I’d like to practice the next one on you.” Though that’s often the case, no patient would tolerate such honesty! Instead, most surgeons reach a point where they feel they’ve had enough “training” to attempt a difficult procedure on a docile patient, all the while knowing beyond a shadow of a doubt they are far from really mastering what they are about to do. Often, such procedures are quite successful, but there are poor outcomes too. Often the patient is disappointed because he expected more than his surgeon could provide at a given point in time, despite what he was promised pre-operatively. Same patient, same doctor, same procedure five years down the road would most likely provide a far better outcome. Wise surgeons have learned the happiest patients are those to whom they have under promised and over delivered.

    Unfortunately, however, the nature of medicine and surgery demands that practicing doctors take on cutting edge new procedures that have an extremely long learning curve i.e. robotic prostatectomy. I’d say it takes several hundred procedures before a robotic surgeon really “masters” the procedure — and even then only if he has a degree of talent to begin with. But, nevertheless someone must be first, second, third etc. I don’t have an easy solution because this “way of doing it” is time tested world wide, and generally accepted as the only way, though it is never widely publicized.

    My only advice to patients would be to study and learn all you can handle about your condition before you even discuss a procedure with a doctor. Be your own advocate and be a good one. No, be a great one! Don’t be taken in by advertisements, they will generally mislead you, especially those on the internet. Get many opinions and ask every question you can think of. Every penny you pay for information will be well spent. Eventually you will feel confident that you really know something about your condition, and with that newly learned knowledge it will be far easier to find a surgeon who you can really trust to get you the results you want. If not, start over.


  2. I can only speak for myself since I’m not a medical doctor, but I had a robotic radical prostatectomy and as instructed got the protective undergarments for use after the catheter was removed, but never needed them. I realize I was lucky, but I also had a great surgeon with a lot of experience. My case was complicated by the fact that the cancer had gone out of the prostate, which may or may not have had any impact on sewing me up. My issue has been ed which I’m slowly recovering (since May ’12). I’m getting ready to go in for radiation so I hope that doesn’t undo any of the dr’s good work.


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