So, we have a couple questions regarding surgery side effects from our YouTube channel.
This person is wondering, "Is there any way to not damage the nerve bundles during surgery?"
In fact, they're wondering if all treatments damage nerve bundles?
There is something called uh nerve sparing surgery which is sort of assumed when people undergo
a modern radical prostatectomy that they're going to attempt to do nerve-sparing surgery.
There are situations where doctors are operating on people where the cancers got out the edge
of the gland and they're not going to try and do nerve-sparing in those individuals.
Sadly, I don't know why they even consider surgery because there are certainly other options such as
radiation which give at least some hope of retaining normal sexual function afterwards,
but for the most part, any standard treatment that is administered to cure prostate cancer
involves targeting the whole prostate, and as a result, the nerve bundles, which are right
on the surface of the gland, are at risk for being damaged, and this occurs to variable
degrees depending on the different types of treatments that you consider.
Surgery and radiation and the other options that are out there. The only way to
sidestep this, of course, is to think about some sort of focal therapy, and I believe
we've talked about focal therapy before, but if you're able to target the tumor in the prostate
then oftentimes you can at least spare one of the nerve bundles. The prostate is very small, and
if you have a small tumor on one side of the gland, it's still possible that you'll damage the
nerve bundle on that side of the prostate where the cancer is, but you'll be able to completely
spare the other side. Surgical studies where they spare one nerve bundle versus two show, you know,
much better outcomes in men that spare two nerve bundles, but they just retain some function if
they can if they do spare one nerve bundle. So, I think that the answer is to determine if
the the patient is a candidate for focal therapy. Focal therapy is a very new area and it's hard to
find qualified bona fide practitioners that you know can deliver the type of treatment you need,
but it's a very logical next step for the really the last hope for side effect free
prostate cancer because most of the methodologies that use radiation, now,
are not damaging urinary function, they're not damaging rectal function, and we're just
left with a risk of erectile function problems. Sparing at least one nerve bundle and treating a
section of the prostate rather than the whole gland is, I think, is going to be the future.
So, speaking of surgery side effects, we have a patient who's experiencing a large amount of
urinary incontinence, and so they're wondering, "What treatments are there after they've already
had surgery; they've already had radiation, and they're experiencing this side effect?" There
aren't a lot of options. There's something called a sling procedure which seems to be
generating less and less enthusiasm, and then of course, there are artificial sphincters which are
surgically implanted cuffs that are put around the urethra that have a switch,
literally, that's placed in the scrotum; there's a pump that's placed intra-abdominally that will
cause this cuff to inflate and squeeze the urethra and stop the flow of urine.
These are pretty successful and like any operation
there are potential complications and it's not going to work in everybody,
but for those in whom it is effective it can be a dramatic improvement in quality of life.
How long does it typically last? Do they have to get it replaced at some point?
I think they're pretty durable. Again, not everyone that has one will have a successful
outcome, but for those that do, they can easily continue functioning for 10 or more years.
When you say 'not everyone,' do you have like a percentage like two-thirds will do well with it?
What have you seen regarding your practice? Yeah, I'd say two-thirds to three-fourths of people
that are candidates. I mean, some men are are better candidates for operative
corrective procedures than others, and so if you take people that are good candidates,
you probably have a happy satisfied customers maybe in about four out of five people.
And what would make somebody a good candidate? Well, I think it has to do—I
mean, I think it's better if someone hasn't been radiated. That would be one thing. Irradiated
tissues don't heal as well. Some people have already had other procedures done, and so to
go back a second or a third time to try and get something fixed it doesn't bode as well as someone
who's you know a fresh case, younger people rather than older people—there's a lot of variables.
You mentioned the sling procedure, what is that?
Well, it's a less involved operation where they try and put a mesh across the pubic bone area
and it kind of creates a kink in the urethra that functions sort of like a sphincter. I think people
that have milder cases of incontinence may benefit from that type of operation.
So is the average urologist trained in, you know,
giving sling procedures or performing artificial sphincter implants?
They are, but like any operation,
I think patients are wise to seek out someone that's made this more of a specialty and is doing
a lot of the same operation over and over so that they are very facile and have good skills.
And what would be your minimum number of operations you would think that would be decent?
I don't think of a minimum number of operations. What I think of is a
doctor who has developed a reputation for being excellent at this particular procedure.
If they're just doing it in their spare time then the outcomes are not going to be as good.
Hey everybody, it's me and my dog hunter. We're giving him treats over here,
but yeah, go ahead and check out his Instagram at sirhunterthedal, and go ahead and subscribe
to our YouTube channel we come out with new prostate cancer videos every week. Yes we do.
you