laparoscopic radical prostatectomy

///laparoscopic radical prostatectomy
laparoscopic radical prostatectomy 2017-10-19T10:44:54+00:00

From the Krondgrad Insititute Discussion of prostate cancer laparoscopic radical prostatectomy (LRP) with Pastor Pat Robertson and Dr. Arnon Krongrad.
Experience of A Prostate Cancer Laparoscopic Radical Prostatectomy performed by Dr. Guillonneau, Memorial Sloane Kettering
By Bruce Palmer (patient)

62YR old male, good health at diagnosis.
12/16/02 PSA 7.8 Initial PSA, part of routine physical. Referred to Urologist.
01/8/03 PSA 10.2 DRE Normal

02/19/03 DRE Normal, TRUSP Volume 27cc, 6 core biospy taken. Biopsy confirms PC. PC found in 5% of one core. Gleason Score 3+3. I, like many folks newly diagnosed with PC, got quite aggressive in trying to understand this disease.
I met or spoke with a total of nine professionals. Without exception, they all pushed their own particular treatment as the “best” solution for my specific circumstance. As Dr. Strum suggests, you need to take ownership of your own case, understand your disease and make informed choices, yourself.

4/14/03 PSA 8.0 Free PSA 6.3%
A variety of factors led me to conclude that “watchful waiting” was not for me and that I would treat this cancer aggressively. I further decided that my first choice for treatment would be LRP if I could locate a surgeon whose results were published and comparable to RP. The best results I could find were from a surgeon, Dr. Guillonneau in Paris who developed many of the early LRP procedures. He has recently moved to NYC and started to practice Memorial Sloan Kettering Hospital Manhattan. I called for an appointment and met with him.

4/22/03 PSA 8.34 DRE T1c
I met with Dr. Guillonneau and his staff. A second opinion review of my biopsy slides confirmed PC and Gleason of 3+3. Dr. Guillonneau agreed to treat my cancer and we established a schedule.

/21/03 Started Kegel exercises on the recommendation of my wife (an RN). This was one month prior to surgery and I now believe that becoming familiar with Kegel exercises helped me substantially with my post surgical continence.

7/16/03 Pre-surgical MRI and routine pre-admission processing.

7/21/03 LRP procedure performed. Checked into hospital at 10:00AM.
Surgery lasted about 3 hours ending at 4:30PM. In recovery room until 8:00PM and then taken to hospital room. I indicated a desire to sleep at around midnight and was encouraged to get up and walk prior to sleeping to avoid the nurse having to awaken me. I walked for around 15 minutes with only slight discomfort. In fact, it felt quite good to stand. Pathology testing of the removed prostate and related material showed clean margins. Tumor was upgraded to Gleason 3+4. The surgeon said that he had been able to spare nerves on both sides.

7/22/03 Both abdominal drains and IV were removed and I was discharged from the hospital at 4:00PM with a urinary catheter in place. The two block walk to my hotel was not unpleasant and was much more attractive than trying to get into a taxi which would require bending over. My medication at this point was Celebrex twice a day and Hydrocodone to be taken as needed. I never needed the Hydrocodone and only took it on the first two nights in order to help induce sleep. Pain was never a significant issue for the entire experience. I walked further each day and walked over 4 miles on the 4th day after surgery.

7/25/03 Catheter removed and all medications stopped. Told to reduce fluid intake to 40 oz per day and NOT to do any Kegel exercises until one
week after surgery.

7/28/03 Returned to hometown by air (approximately a 1 hour flight). Had been told not drive, lift or do anything strenuous for a total of 3 weeks after surgery. I was able to do normal office kinds of work to a level of approximately 75% during week 2 after surgery and 100% starting week 3. Urinary incontinence made air travel impractical so all work was done from home.

8/11/03 First attempt to run and had no problem with 1.5 miles. I found that I had no urinary control while running. Aside from no air travel I was living a very normal routine at this point. I could do anything I wanted and mowed the yard this day.

9/2/03 First post surgery PSA test showed nil result. With a nil result on this test I have rather favorable odds that my cancer was organ confined and that I’m now cancer free. Time till tell. My local urologist does not favor the ultra-sensitive PSA test for post surgical PSA monitoring.

9/14/03 First post surgery business travel. No issues.

9/21/03 I have good urinary continence at this point. The continence issue is one of gradual improvement over these 8 weeks since surgery. I had good nighttime control from the day my catheter was removed but with a reduced bladder capacity. I initially got up between 2 and 4 times per night (down to none or one now). By week 3 I had good control when sitting or walking, with trips to the bathroom starting every 20-30 minutes and now down to something close to normal. Problems with “stress” have been the last to be controlled and remain somewhat of an issue.
At 8 weeks post surgery I still wear a pad (Thin Maxi) but it is never soiled enough to require changing. I still have very little control while running (running approximately 3 miles per day). I have had no return of erectile function but it is too early to expect it. I have noted occasional modest swelling that suggests that this function will return after some time. In addition to being quite lucky I have received some very good support from lots of folks over the past 8 months. My surgeon and his office and medical staff were simply outstanding and competent beyond measure. The hospital staff was similarly exceptional. Closer to home, my wife has been a real gem. She knew what was coming very much prior to my seeing it and provided an unending level of reassurance and support. I could not have come through this so easily without her attention and support. I had the assistance and best wishes from a host of friends and fellow-workers.
Hints and Tips: Here is a short list of suggestions.
1. Step 1 is to buy the Strum/Pogliano book and read it.
2. If your urologist is not supportive of what the book suggests you should be doing or considering, get a new urologist (My initial urologist seemed quite annoyed when I mentioned that I would be looking at other surgeons and other treatment options. He does approximately 20 RPs per
year and the tracking of his surgical results is not available. I eliminated his surgery solution as an option quite early on.).
3. Don’t take any non-reversible action until you are comfortable with it.
4. Buy a pair of basketball pants to take with you to the hospital if/when you have surgery. These are the pants that have snaps all way down both sides so they can be taken on and off without having to place your feet through a leg hole.
5. Have a small tube of Vaseline to lubricate the catheter, which can get somewhat uncomfortable on long walks. You will need something like 2″ gauze pads to deal with catheter leakage.
6. Start Kegel exercises prior to your surgery. There are two reasons for doing Kegel exercises. One is to help strengthen the muscle that you will need for urinary control after your prostate (plus primary urinary sphincter) is removed. More important is learning which single pelvic floor muscle you need to flex in order to control urine flow. I found the most effective way to do this was during urination. Allow the stream to flow for one-second. Interrupt the stream and hold for a count of 5. Allow the stream to flow for another second and interrupt again. Continue… You will be able to do 10 to 20 or more interruptions during each urination. It’s easier while seated. Gradually increase the count to where you are holding the interruption for 20 seconds or more each time. Concentrate on neither your abdominal muscles nor anal sphincter being contracted at the same time.
7. I found the best underwear solution to be the Sir Dignity Plus fitted
Brief along with the Dignity Extra Duty Absorbent Pads.