RESULTS FOR Da VINCI PROSTATECTOMY
I periodically update my results (updated 8/06/2006) in terms of cancer control (positive margins), and urinary control (how many pads do my patients use to control their urinary leakage), and sexual function. In my practice I routinely perform robotic prostatectomy on patients that may lead to poorer outcomes including aggressive cancers, very large prostates, prior pelvic and prostate surgery, and many others. This data should not be taken by anyone as their expected results and they should seek personal advice from a licensed urologist.
Cancer control- The best long term marker of cancer control is the mortality due to prostate cancer. This takes decades to follow. PSA recurrence after surgery is a good marker for cancer recuurence, but often takes years. The amount of positive margins (meaning cancer cells may have been left behind) is a good short term estimate of cancer control. Although not all patients with positive margins recur and patients with negative margins can have cancer recurrence, this is our best test.
|
Positive margins |
|
T2 |
T3 |
|
Patient 1-26 |
7/21 (33%) |
5/5 (100%) | |
|
Patient 27-69 |
5/40 (13 %) |
1/3 (33%) | |
|
Patient 70-146 |
3/67 (4.5%) |
4/10 (40%) | |
T2 cancers are those confined to the prostate. T3 cancers are those that have extended outside the prostate. I have seen a trend in better cancer control as I have performed more procedures.
Blood loss- None of my 146 patients have received any blood. 2 have come close and needed longer hospital stays. One was a hemophiliac and one was put on blood thinners after surgery for another medical condition.
Hospital Stays- Most patients go home the next day.
|
|
Same day |
1 night |
2 nights |
> 2 nights |
|
First 34 pts |
- |
44 % |
38 % |
18 % |
|
Pt 35-146 |
1 % |
90 % |
8% |
1 % |
Urinary control- Most men have some leakage after radical prostate surgery. The following chart depicts how many men pads per day my patients have needed to wear.
|
First 42 patients |
0 pad |
1 pad |
2 pads |
> 2 pads |
|
1 month
3 months
6 months |
24 %
64%
65% |
21 %
7%
25% |
12 %
19%
10% |
43 %
10%
0% |
|
|
|
|
|
|
|
| ||||
|
Patients 43-129 |
0 pad |
1 pad |
2 pads |
> 2 pads |
|
1 month
3 months
6 months
|
36 %
68%
too early |
39 %
18% |
12 %
11% |
13 %
3%
|
|
|
| |||
The most current group of patients have seen better urinary conrol. I believe the first group was similar to open surgery. As I have performed more dvPs, the control has been considerably improved to my open results. The majority of this is too technical improvements in the operation, but I also have been stressing that patient's perform preoperative Kegel exercises more recently.
Return of erections- Most men have lost their erections after radical prostate surgery. I think originally the results were similar to open surgery, but have I had more experience and I have adopted some newer techniques to spare nerves I have had better results. The data below only includes men that have normal erections to start and had both nerve bundles spared during surgery. Most urologists judge the ability to have erections with the addition of medicines such as viagra, levitra, and cialis.
|
Savatta |
# pts |
Capable of Intercourse +/- PDE5 inhibitors
At 1 month |
|
First 32 pts |
16 |
2 (13%) |
|
Pt 33 – 59 |
16 |
4 (25%) |
|
Pt 60 – 129 |
32 |
13 (41%) |
