Re: Suspicions confirmed?? ED causes
len
> While researching PCa treatments I came across some diagrams of how
> the operation was done and what was removed. At the time I couldn't
> help thinking "why are they just cutting all those blood vessels out?
> Surely they must serve some purpose?" That lead me to post the
> following question on MedHelp Forums. Question and Answer below. I'm
> rather disappointed to find that something that seemed rather obvious
> to me, just a simple patient, apparently had never been given serious
> thought by the physicians performing the surgery. How many ED
> outcomes have been caused by surgeons just hacking these blood vessels
> out??? More and more I feel I have been badly served by the medical
> profession.
>
> MedHelp Member's Question
>
> surgery details PCa
> by JBond
>
> , Aug 09, 2008 08:58PM
> One of the common results of prostate removal is ED. I looking at
> pictures showing how the prostate is removed it looks like there is a
> large bundle of blood vessels that is removed along with the prostate.
> The removal of these vessels is never mentioned as a contributing
> cause of ED yet it seems that a large part of the ED is caused by
> interruptions in the blood supply to the penis for various reasons.
> What's the purpose of those blood vessels that are cut and do they in
> fact supply blood to the penis. If not to the penis, what do they
> supply blood to?
>
> Doctor's Answer
>
> by Ash Tewari, MD, M.Ch.
>
> Aug 15, 2008 11:12PM
> To: JBond
>
> The need for, not just nerve sparing, but artery sparing prostatectomy
> is an emerging thought in the current discourse amongst surgical
> urologists. It has been well established that saving the cavernous
> nerves around the prostate is key in preserving erectile function.
> However, there has been increasing evidence that minimizing ischemia
> of the penile tissue by sparing the accessory arteries can lead to
> better outcomes following radical prostatectomy.
>
> Sincerely,
>
> AKT
I think you are overreacting.
Surgery is not a simple either or proposition. Certainly, surgeons
are aware that the blood supply to the penis must be preserved. Were
it radically interfered with, then not only would men be impotent,
they would also suffer much more serious effects. The fact is that
many factors affect whether or not a man will be permanently impotent
after surgery. Two very important factors are the man's age and the
skill of the surgeon. The best surgeons can preserve impotence in
over 80 percent of their patients younger than 60, and a few can do
even better than that.
Remember that the primary aim in performing an RP is to remove the
cancer. So the surgeon must weigh making sure all the cancer is
removed against preserving potency. With time there will certainly be
incremental improvements in the techniques employed. The doctor who
answered your question was just saying that surgeons are beginning to
realize that preserving those blood vessels may be important. I
doubt strongly that the thought had never occurred to them. My guess
is that they didn't think the evidence was there for doing it, so they
opted for removing them in hopes of preventing spread of the cancer.
With time and experience, they may be seeing evidence that they can
preserve those vesssels and not increase the risk of spread.
In any event, keep in mind that no surgeon will ever be able to
guarantee potency after an RP. If nothing else, the trauma to the
area will have some effect. As men age, the nerves and blood vessels
necessary for erects deteriorate in any case, so it will always be
true that older men will face a significant risk of impotence after
treatment for prostate cancer.
Fortunately, in many cases impotence can be treated. I used a pump
for 18 months following my RP and could have continued that way
indefinitely, but furtunealy erections returned. Many men use
injections successfully. If one is sufficiently motivated, there is
always the possibility of implants.
BlDn10
patients younger than 60, and a few can do even better than that."
I don't think that came out right, Len. :-)
BUT (that's a big "but"), as I've said many times, the uros'
definition of potency is different than ours. The fact is that very
few men end up unchanged. The procedure is still rather brutal.
Anything that goes to the penis should be saved if possible. IMO
Bill
Memphis
len
Thanks for the correction. I meant avoid permanent incompetence.
I agree that not many men end up exactly as they were before surgery.
If nothing else, almost all men are impotent for some time after
surgery, even if erections return I guess whether you are
disappointed or not depends on what you expect. In my case, at age
67, my surgeon told me my chances of being permanently impotent were
about 50-50. But I also knew that impotence was treatable. I was
impotent for 18 months, during which time I used a pump. Even after
erections returned, I would hardly claim the experience was, except on
rare occasions, the same as I remembered it before surgery. But the
intensity of sexual experience tends to decline with age in any case,
so it is very hard to for me to judge if where I am now, 8 years
later, at age 75, would be any different had I not had prostate
cancer. All things considered, I think I am doing reasonably well in
that regard, and I suspect better than many men my age who never had
prostate cancer. And my cancer has not recurred.
Any man faced with a diagnosis of prostate cancer must balance the
risk of side effects against the risk of metastatic prostate cancer.
I feel it is a mistake to obsess about the side effects and thereby
make a foolish decision.
JerryW
"len" <l...@math.northwestern.edu> wrote in message
news:f5bf0479-f5be-46ae...@d45g2000hsc.googlegroups.com...
> On Aug 22, 12:10 pm, BlDn10 <bl-d...@comcast.net> wrote:
>> "The best surgeons can preserve impotence in over 80 percent of their
>> patients younger than 60, and a few can do even better than that."
>>
>> I don't think that came out right, Len. :-)
>>
>>
>> Bill
>> Memphis
>
> Thanks for the correction. I meant avoid permanent incompetence.
>
I'm not sure that came out right, either! :-)
--
JerryW
Please respond to group; email address is not valid
2/11/04 PSA 2.6, Suspicious DRE (age 62)
2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe
5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes
Fully continent by 9/04
PSA through 4/22/08: <0.1
(But, maybe permanently incompetent.)
len
I give up. but whatever is giveing me problems has nothing to do with
my prostate cancer treatment.