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Archive for the ‘no scalpel vasectomy’ Category

my hypocrisy will go only so far...

 

The things people search for (it is often a question that comes up “after” they have been diagnosed or treated for prostate cancer) that got them to this  blog. This also provides for me a subject matter or topic for that day’s post. “Like taking candy from a baby.” Thanks to all for your support.

prostate cancer diaries 561
prostate diaries 251
frank zappa prostate cancer 146
partin tables 2010 117
bill clinton cancer 85
prostate vs breast cancer 83
famous men with prostate cancer 73
theprostatedecision.wordpress.com 73
elevated psa biopsy 71
famous prostate cancer sufferers 71
prostate cartoons 67
prostate nerves 67
prostate nodule 62
frank zappa cancer 60
alberto sabatino 59
prostate spasm 55
richard albin psa 55
nanoknife prostate 55
prostate nodule biopsy 49
prostate cancer 44
prostate biopsy experience 42
prostate biopsy 41

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mchugh's rule for success (not that i am successful) for doctors....one wife (if possible), one city, one practice

If you see the nerves better with the robot and “you spared them” why is it then that people still have erection issues? Why is that to date there is no better success rate shown by the robot vs traditional open prostatectomy? The following is quite good.

Look at the next video…does it appear that they actually see “the nerves” or they where they would be? Can you see a “nerve.” If they think they see the nerves, then do they see the “subvisual” branches that then go to the prostate? I think not. And that is why there is so much variance in how people do after a “nerve sparing ” prostatectomy. There is still a lot we don’t understand and I am bit disappointed in surgeons that announce to their patients,” I spared your nerves.” I think it would be fairer to say, ” I feel very good about my nerve sparing technique and my dissection today. I am optimistic that we have optimized your chances of sexual recovery.” In the following video, the doctor doing the procedure has done as many as anybody in the world. He says in the video,”The path of the neurovascular bundle is clearly delineated.” That is a fair assessment of the surgery. Most commonly you see “where it should go and you spare that” not “I saw the nerves and I spared them for you. Now go and tell your friends that your “nerves were spared.” A big difference my friend.

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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.

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CNN’s Heath Minute About Northeast Gerogia Urological Assoc. March Vasectomy Madness

A vasectomy is "tying the knot" a second time but for a different reason

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i can tell you a lot about you by knowing who you love.....

Had to get that “moustache dreadful picture of my hair off the main page of the previous post. A nurse of mine asked,” Are those plugs?”

The answer to the question posed above: Drum roll please……

  • Yes you can have sex the morning of a prostate biopsy
  • Yes sex before a PSA will make it higher
  • No a rectal exam won’t make the PSA higher
  • Yes you can have sex after a biopsy
  • No it won’t hurt your wife
  • Yes there will be blood, to what degree varies
  • Yes, when the color of the semen turns rusty looking (old blood and iron) it is about to stop
  • No, repeated biopsies of the prostate hurt it or “make it leak”
  • Yes…to all the wifes out there….good try on another reason to postpone sex but having had prostate biopsy isn’t one of them….no extra charge to all the men out there

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a little knowledge is a dangerous thing

Orvis is having a dog cover contest. I sent one in of Chloe the other day and my daughter will be sending this one in for her dog, Brother, and our other dog, Penelope.  There is no  way they won’t win something.

Since I have used them so often on this site, maybe I should call the picture….Prostate Pups

Or maybe…prostate cancer sniffing pups—-remember the article about prostate cancer chemicals getting into the urine and that dogs would be able to sniff for cancer.

Pss…the comment and response on the previous post is fun and a hint to the topic for my next book…take a look.

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it there are many treatments for a disease, then there is no one good one

When the prostate is removed the surgeon has to put the bladder back together with the urethra. A catheter is placed to “stent” this area of the anastomosis. The reason a catheter is used and left in from 6-14 days is to allow time for this area to heal. In doing so keeping urine from leaking out into the area where the prostate was removed.

So…you have the bladder sewed to the urethra and going through this is a catheter. The catheter, a foley catheter, has a balloon on it that keeps it from falling out. The balloon is just inside the bladder on the proximal side of the anastomosis.

There is a space around the catheter that allows both blood and urine to leak around the catheter, through the anastomosis, and then out the tip of the penis, not through the catheter, but around it.

In the case of urine “flooding” around the catheter, this occurs because a bladder spasm forcibly pushes urine not through the catheter but around it. This is unfortunate and not ideal and is the result of a bladder spasm. The bladder spasm occurs because the balloon is about the size of a golf ball and the bladder doesn’t like it in there and tries to spit it out by contracting, much as it would do to eliminate urine. Sometimes the cause is a clot or something inside the foley preventing urine from draining so the bladder and the urine take the next easiest course….the bladder expels it not through the catheter, but around it.

In the case of blood coming out around the catheter and showing up at the tip of the penis, it is a similar scenario and is not big deal. In this case blood from the anastomosis or blood in and about the anastomosis finds its way down along side of the catheter and then out the penis. As long as the urine in the bladder and subsequently inside the foley and the collection tubing is patent and draining well, bloody or not, urologists are fine with the situation.

So flooding around the catheter is common and the result of a bladder spasm and should be short-lived, unless the catheter is blocked and in that case it must be irrigated free of clots or an obstruction.  Blood around the catheter is very common and not an issue of concern.

If there are clots inside the foley and the bladder cannot drain…that is a problem. Manual irrigations will usually unobstruct the foley. Unlike any other prostate or bladder endoscopic surgery, the options for the patient and urologist after a prostatectomy are limited. You can’t take out the foley and just put it back in because of fear that one might disrupt the anastomosis. So extreme care should be taken in irrigating the catheter and in no circumstances should a nurse remove a catheter after a prostatectomy because of it not functioning properly. Hopefully, gentle irrigation will resolve the majority of cases where a prostate has been removed and yet the catheter is draining improperly.

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