In 2001, the way prostate cancer was treated was revolutionized by the introduction of the da Vinci surgical robot.
Men with prostate cancer faced a new dilemma. The robotic procedure was heavily marketed by hospitals and treatment centers with unsubstantiated claims and benefits.
According to a 2011 study by Johns Hopkins Medicine, as many as four in 10 hospital websites were making unsubstantiated claims about the benefits of robotic surgery.
The two prominent quality-of-life issues associated with living without a prostate are the loss of urinary control and the loss of erectile function.
When you read or hear that success rates in these two areas are in the 90% range, it's highly probable you're reading hype.
The study found that 164 of 400 hospital robot-surgery websites surveyed “overestimate the benefits of surgical robots, largely ignore the risks, and are strongly influenced by the product’s manufacturer," according to a Johns Hopkins news release.
How can men evaluate whether they are hearing the truth? Dr. Claus Roehrborn, a professor and chairman of the urology department at University of Texas Southwestern Medical Center in Dallas, told the Australian Financial Review: "A year after a radical prostatectomy 15 percent will still be leaking urine in some way, and among those who experienced full potency before surgery only one in six men resumed sexual activity."
A UCLA Health post on robotic prostatectomy cites a study from Memorial Sloan Kettering that found that among 11 surgeons performing radical prostatectomy, 12-month sexual potency ranged from 8% to 50%, indicating that there is significant variation in technique and outcomes.
Then, you find studies like the one from the University of California at Urvine, which says, "Our data has shown that among preoperatively potent men aged less than 65 who underwent a nerve-sparing procedure, 89.7% were able to have satisfactory erections at 24 months."
There are lots of variables that influence the return of potency following a prostatectomy. The skill and experience of your surgeon is an important factor. Your age and sexual functioning before surgery are also important, but there isn't a predictive variable that's fool-proof.
I had an experienced surgeon. Before surgery, I completed a pre-surgery sexual history. I began penile rehabilitation before surgery. I was told the chances of my regaining my erectile abilities were more than 90%.
Four years after surgery, nothing — including penile injections — worked. I was told I'd be impotent for the rest of my life. I don't believe my surgeon lied to me. I believe he overestimated my odds because he believed those odds were true.
Thanks to social media, I've spent the last seven years in contact with men and couples struggling with life, love, and sex without a prostate. The most unforgettable and tragic letter came from a widow. Her young husband had his prostate removed. He was cured of cancer but never regained erectile functioning. Too embarrassed to seek help, he began abusing alcohol. Eventually, he committed suicide.
I never stopped wondering if he died of ignorance. When I was told I'd be impotent for the rest of my life, the doctor who told me this never spoke to me about penile implant surgery. The irony is that he was the doctor who performed my implant surgery!
I regret that I never asked him why he didn't tell me about that option on the day he told me I'd never regain my erectile abilities. This was a devastating loss. I was seriously depressed before I reached the parking lot.
The widow's letter and the months I spent needlessly hopeless and depressed was the reason my wife and I wrote our award-winning book, "Everything You Never Wanted to Know About Erectile and Penile Implants."
Based on my experience, I don't believe giving men the odds of success is helpful. I believe informing a pre-surgery patient that he could experience a complete loss of erectile functioning is more realistic.
I also believe that men who experience the loss of erectile functioning after surgery should receive follow-up with a healthcare professional until it's known where he landed post-surgery. In some cases, this means some form of follow-up for a minimum of three years.
Men and couples faced with permanent erectile dysfunction need additional supportive services.
In most cases, recovering from robotic surgery takes a few weeks. Recovering from the side effects and quality of life issues brought on by living without a prostate, that takes a lifetime. No one prepares you for this reality before surgery.
Note: This article appeared in Prostate Cancer News Today
Rick Redner and his wife Brenda Redner wrote two award winning books. The first:
provides men and couples with information and support before, during and after prostate surgery.
Their second book was written for couples living with!erectile dysfunction. After living with erectile dysfunction for four years, Rick chose penile implant surgery. The couple share how implant surgery changed their lives and relationship.
The title of their book is: