Complications after surgery, in germany

hopeful and optimistic
hopeful and optimistic Member Posts: 2,333 Member
edited March 2018 in Prostate Cancer #1

This article, (Repeat prostate biopsies do not raise the risk of post-prostatectomy complictions) found on page one of the Feb 2018 ustoo hotsheet mentions information that have been a focal of discussion at this board:

"Results showed that 45.9%, 57.9% and 60.9% of men achieved potency at one, two and three years after RP, respectively"

and, " UI (Incontinence) rates followed the same trend: By one, two and three years after RP 87.9%, 90.9%, and 91.9% of all men, respectively, had achieved continence"

 

With respect to ED, MK1965 when he talks about ED after surgery that happened to him and to many,  is NOT out of line when he refers to the subject since in this article ,  over half experience ED after one year, and 40 percent still after 3 years.

 

Note:

The HOTSHEET is published monthly by the USTOO organization, and is available on the the internet, as well as in print form, that is available at most local meetings sponsored by ustoo organization. If you are interested in building your knowledge I recommend that you regularly read this publication.

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Comments

  • MK1965
    MK1965 Member Posts: 231 Member
    edited March 2018 #2
    Hot sheets

    Thanks for sharing.

    Also attended this month TX US TOO support group meeting and also got February HOT Sheet issue and read article you are talking about. As you mentioned, it happens way more often then guys on this forum want to accept and stop bleming mental issues as cause for all unsuccessful RP. My case is not “worst” as someone called it. It is one of many and it happens that I am very openminded person who talks about it without shame. I lost ability to achieve erection, I lost length, lost QOL, and all of that derailed  my relationship.

    Sometimes, no treatment is best treatment. Rushing and listening to others is never good. Treatment choice should be each one own choice.

    MK

  • VascodaGama
    VascodaGama Member Posts: 3,583 Member
    Aspirin Found to be beneficial in Erectile Dysfunction issues

    Just adding to your thread an article on an ED study indicating that "Aspirin were Found Effective for Erectile Dysfunction".

    https://www.renalandurologynews.com/erectile-dysfunction-ed/aspirin-erectile-dysfunction/article/740011/

     

  • Grinder
    Grinder Member Posts: 487 Member
    edited March 2018 #4
    the actual study's abstract

     Effects of prostate biopsies on functional outcomes after radical prostatectomy



     


    Highlights

     

    Repeat Bx compared to single Bx has no influence on erectile function after RP.

    Repeat Bx compared to single Bx has no influence on urinary continence after RP.

    AS patients can be consulted that repeat Bx do not result in worse functional outcome.

     



    Abstract

    Purpose

    Growing acceptance of active surveillance (AS) results in a relevant number of patients who will undergo radical prostatectomy (RP) after multiple biopsy sessions (Bx) due to cancer progression. The effect of repeat Bx on functional outcomes after RP remains controversial.


    Methods

    Overall, 11,140 patients who underwent RP from 2007 to 2015 were analyzed. Number of Bx sessions (1 vs. 2 vs. ≥3) before RP was examined. Association between number of Bx sessions and erectile dysfunction (ED) and urinary incontinence (UI) was assessed by univariable and multivariable logistic regressions.


    Results

    A total of 9,797 (87.9%) had 1 Bx, 937 (8.4%) had 2 Bx, and 406 (3.6%) had 3 or more Bx. Median age was 65 years (IQR: 59–69). Increasing Bx sessions were associated with advanced age at surgery (1, 2, and ≥3 Bx: 65, 65, and 67 years, P<0.001); 982 (45.9%), 906 (57.9%), and 597 (60.9%) patients achieved potency at 1, 2, and 3 years after RP, respectively. On adjusted analysis repeat Bx compared to initial Bx had no influence on ED at 1, 2, and 3 years. At 1, 2, and 3 years after RP, 6,107 (87.9%), 4,825 (90.9%), and 3,696 (91.6%) patients achieved continence. Number of Bx session had no influence on UI at follow up.


    Conclusion

    Our findings demonstrate that ED and UI rates are comparable among patients undergoing RP after initial and repeat Bx sessions. This is of importance when counseling AS patients. No adverse functional outcomes are expected if AS has to be discontinued and RP as curative option is contemplated.




  • Grinder
    Grinder Member Posts: 487 Member
    edited March 2018 #5
    The actual study abstract

    stract

    Purpose

    Growing acceptance of active surveillance (AS) results in a relevant number of patients who will undergo radical prostatectomy (RP) after multiple biopsy sessions (Bx) due to cancer progression. The effect of repeat Bx on functional outcomes after RP remains controversial.


    Methods

    Overall, 11,140 patients who underwent RP from 2007 to 2015 were analyzed. Number of Bx sessions (1 vs. 2 vs. ≥3) before RP was examined. Association between number of Bx sessions and erectile dysfunction (ED) and urinary incontinence (UI) was assessed by univariable and multivariable logistic regressions.


    Results

    A total of 9,797 (87.9%) had 1 Bx, 937 (8.4%) had 2 Bx, and 406 (3.6%) had 3 or more Bx. Median age was 65 years (IQR: 59–69). Increasing Bx sessions were associated with advanced age at surgery (1, 2, and ≥3 Bx: 65, 65, and 67 years, P<0.001); 982 (45.9%), 906 (57.9%), and 597 (60.9%) patients achieved potency at 1, 2, and 3 years after RP, respectively. On adjusted analysis repeat Bx compared to initial Bx had no influence on ED at 1, 2, and 3 years. At 1, 2, and 3 years after RP, 6,107 (87.9%), 4,825 (90.9%), and 3,696 (91.6%) patients achieved continence. Number of Bx session had no influence on UI at follow up.


    Conclusion

    Our findings demonstrate that ED and UI rates are comparable among patients undergoing RP after initial and repeat Bx sessions. This is of importance when counseling AS patients. No adverse functional outcomes are expected if AS has to be discontinued and RP as curative option is contemplated.

  • Grinder
    Grinder Member Posts: 487 Member
    Correction

    After further study, i was wrong.

    They do list the types of surgery under the umbrella term RP. 

    81.8% of the patients in the study had OPEN surgery.

    18.2% of the patients in the study had robotic nerve sparing surgery.

    draw your own conclusions.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Erectile dysfunction in robotic radical prostatectomy: Outcomes

    Quote from this  study, "  Data show that 60% of men report ED 18 months post-operatively,[5] 20% report erections strong enough for intercourse at —5 years of follow-up[5] and only 20% of men return to pre-operative erectile function at —1 year post-operative"

     

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220385/

     

    ........................

    If you wish I can add other studies.

     

  • Grinder
    Grinder Member Posts: 487 Member
    edited March 2018 #8
    we're not the bad guys here

    After consulting the actual study instead of the ustoo article, please note this was a sampling of 11,140 patients in one clinic in Germany. 

    The incessant disregard of variables when researching ED after RP in this forum is disconcerting. Even this study emphasizes the importance.

    The goal of this study was to test correlation between multiple biopsies and ED after RP, not to establish frequency of ED after RP. Not to mention it was a very small statistical sample of one single clinic in a European country. Not to mention it does NOT diffetentiate between open surgery, robotic surgery prior to DaVinci, and DaVinci nerve sparing surgery under the umbrella term RP.

    For some reason, you continue to paint us as the bad guys when we insist on accurately assessing what happened to MK rather than apoealing to emotions of disappointment and outrage.

    The problem remains... What was the variable between Cleveland's successful surgery and MK's unsuccessful surgery? 

    If you want to help patients in the future decide their best course of treatment, then we have to know that that variable is, and not condemn RP wholesale. Instead future patients are warned to shy away from RP, and we are reprimanded as if we are paid consultants for a urology scam getting paid for referrals. 

    No, I just want to know what the variables are so future patients  make an informed decision.

  • Grinder
    Grinder Member Posts: 487 Member
    Sloppy science

    I do not need to follow up every study you post. If you were doing journal research for a n institute you would be dismissed, because you are looking for research biased to your opinion, and failed to provide the particulars in the first study you quoted, making the quoted content appear to validate your opinion when it did not.

    And... "20% report erections strong enough for intercourse at 5 years of follow up"... again ignoring variables in this study.

    I have no interest in getting into an "I'm right and you're wrong" contest here. I acknowledge that one side effect is 100% of the time... penile shortening. I try to warn everyone who posts in this forum, and the urologists certainly do not inform patients of this side effect.

    But for the sake of accuracy, they need the truth about the ED, and not wholesale condemnation of the RP procedure based on studies quoted out of context.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Instead of attacking my

    Instead of attacking my competency to do research and MK1965 emotional status as you and the other pro surgical individuals have done, please provide research that support that there is a low rate of ED resulting from surgical intervention. I'm sure that you, as an intelligent man, who is able to make these determininations about others,  will have the results of  your research readilly available to share that will indicate this.

    You say, "But for the sake of accuracy, they need the truth about the ED", so, please correct the information that I provided  with the results of your research

  • Clevelandguy
    Clevelandguy Member Posts: 808 Member
    edited March 2018 #11
    All treatments have side efffects

    Hi All,

    I thinks it's pretty common knowledge that if you get surgery either open or robotic you will have ED & leakage issues, usually within a 0-12 month recovery time they lessen, sometimes if the surgery goes bad you are left with permanent ED or leakage.

    With radiation very few side effects during treatment with possible side effects later on(month to years) sometimes severe, sometimes not(damage from the radiation on un-intended targets).  People just need to be aware of the side effects and make your choice.  There is no wrong or right treament option, you need to pick one if you want the cancer gone and then realize that you could or will have some of these side effects.  Very simple guys, no magic here.  As people on this board that have gone through these treaments we should share our experiences and make sure people coming her for gudiance know the risks of any treament.  Again there is no right on wrong treament, surgery & radiation both have side effects.

    My surgery was successful in removing my cancer(I hope,only time will tell) but I did walk away with a slight stress leakage issue which I am willing to live with as a consequence of my surgery.

    Lets cut down on the personal attacks and help new people coming to this board gain from our experiences. A lot of these personal attacks accomplish nothing except making us look like immature adults.

     

    Dave 3+4

  • MK1965
    MK1965 Member Posts: 231 Member
    More bad staff .....

    Prostatectomy an ED - World journal of men’s health - Aug 2016; Capogrosso et all 

    .....18 months after RP 60% of men reported an inability to get an erection, at 24 months it was 41.9%

    ( my underststing is with PDE 5 help, wondering about spontaneous, how low is that?)

    MK

  • Clevelandguy
    Clevelandguy Member Posts: 808 Member
    MK1965 said:

    More bad staff .....

    Prostatectomy an ED - World journal of men’s health - Aug 2016; Capogrosso et all 

    .....18 months after RP 60% of men reported an inability to get an erection, at 24 months it was 41.9%

    ( my underststing is with PDE 5 help, wondering about spontaneous, how low is that?)

    MK

    Question?

    MK1965,

     Robotic nerve sparing techniques have a much better rate of success on ED.  Again that all depends on how involved the cancer was around the nerves.  I think this was from the same report that you sighted, August 2016:  "RARP(Robotic Assisted Radical Prostatectomies) series reported potency recovery rates of 32% to 68%, 50% to 86%, 54% to 90%, and 63% to 94% at 3, 6, 12, and 24 months after surgery, respectively .  Kinda of variable probably based on the amount of nerves vs involvement of the cancer in the study.  Just hope your on the high side of the stats..................

     

    Dave 3+4

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    Clevelandguy, I like your comment about personal attacks. They are not productive, in fact it takes the focus away from the subject. Thank you for that.

    If we might, I recommend that we list research finding along with any and all comments, otherwise we will have a place to vent, but not gain knowledge from this thread.

    Best

  • Grinder
    Grinder Member Posts: 487 Member
    edited March 2018 #15
    Again, variables.

    I find it disturbing that persons in this forum treat their 40-60 stats as a "Wheel of Fortune" where four slots are "permanent ED" and six slots are "ED recovery". 

    With this mindset, a new patient goes into RP treatment believing he has a 40% chance of permanent ED. This is a ridiculous notion being created by taking research out of context and excluding variables that effect that research.

    An informed patient will look at the variables that effected ANY outcome and try to minimize ANY risk, but you would have them only looking at the wheel of fortune as if it is simply a game of chance, or a crap shoot.

    Here are three VARIABLES that are listed by WEBmd:

    " The severity of the erectile dysfunction depends on the type of surgery, stage of cancer, and skill of the surgeon." 

    It is further said that in NON-nerve sparing surgery the likelihood of recovery from ED is possible but extremely unlikely.

    I cannot believe I am being castigated in this thread for demanding that VARIABLES be considered when assessing decisions for treatments. Would someone please explain to h&o that it is the variables that effect outcomes, and those variables must be considered to make an educated decision? Apparently I am not very good at explaining the self-evident.

  • Grinder
    Grinder Member Posts: 487 Member
    Again, variables.

    "Potency was defined as the ability to achieve erections adequate enough for penetration. Return of potency was significantly faster in the RALP group as 50% regained potency at a mean follow-up of 180 days after RALP compared with 440 days after RRP. Krambeck et al. compared 588 RRPs with 294 RALPs[14] using the same definition as Tewari. At 12 months postoperatively, 62.8% of the patients were potent in the RRP compared with 70.5% in the RALP group. Rocco et al.compared 120 patients who had RALP with 240 patients who had RRP. At 12 months postoperatively, they found that 73% of the RALP patients had regained potency, compared with only 48% of the RRP patients."

     Again, what is the difference between the 73% group that regained potency after only one year and 48% group that regained potency? 73% of the robot-assisted surgery group regained potency after one year, whereas other surgeries, open and laparoscopic, only 48% regainedi potency after only one year.

    What was the difference? A VARIABLE.

    Of several studies Medscape investigated, they concluded:

     "Across the boards, these studies have demonstrated that potency outcomes are better in robotic series than in open or laparoscopic series. "

     Why is that so difficult to understand, unless I am not very good at explaining this. Does anyone else think i am being the bad guy for trying to explain this?

  • Clevelandguy
    Clevelandguy Member Posts: 808 Member
    No two are alike

    Hi Grinder,

    Sad to say but no two operations are the same, different tumor size, different patient complications all provide for different outcomes.  I would assume thats why the range in recovery rates, but I would think most people would agree that Robotic assisted surgery in the correct hands will give you better results than open surgery.  I was told the robotic surgeons moves are actually slowed down during the operation to give the surgeon more dexterity and precision. It just goes to prove that there are no guarantees for any surgery, any type of procedure.  Lot of variables need to be understood with the patient before the surgery takes place.  Even in easy surgeries things can go wrong due to unforseen complications. 

     

    Dave 3+4

  • MK1965
    MK1965 Member Posts: 231 Member
    edited March 2018 #18
    Grinder said:

    Again, variables.

    "Potency was defined as the ability to achieve erections adequate enough for penetration. Return of potency was significantly faster in the RALP group as 50% regained potency at a mean follow-up of 180 days after RALP compared with 440 days after RRP. Krambeck et al. compared 588 RRPs with 294 RALPs[14] using the same definition as Tewari. At 12 months postoperatively, 62.8% of the patients were potent in the RRP compared with 70.5% in the RALP group. Rocco et al.compared 120 patients who had RALP with 240 patients who had RRP. At 12 months postoperatively, they found that 73% of the RALP patients had regained potency, compared with only 48% of the RRP patients."

     Again, what is the difference between the 73% group that regained potency after only one year and 48% group that regained potency? 73% of the robot-assisted surgery group regained potency after one year, whereas other surgeries, open and laparoscopic, only 48% regainedi potency after only one year.

    What was the difference? A VARIABLE.

    Of several studies Medscape investigated, they concluded:

     "Across the boards, these studies have demonstrated that potency outcomes are better in robotic series than in open or laparoscopic series. "

     Why is that so difficult to understand, unless I am not very good at explaining this. Does anyone else think i am being the bad guy for trying to explain this?

    Joke of the day

    Grinder,

    ”50% regain potency at 6 months post RARP”

     

    This is the JOKE OF THE DAY!

    i had robotic RP and still 16+ months waiting for sign of life in my deeply comatose non existing penis.

     

    MK

  • lighterwood67
    lighterwood67 Member Posts: 337 Member
    Spoke to a friend

    In my journey, I have been reading on this site and enjoy the factual side of RP vs RT.  I have spoke to both in my hometown.  I already posted what the RT person said.  The RP person told me that he had leakage on the way home after the catheter was removed.  He put another Depends on that night and in the morning no leakage.  He said he does have leakage if he strains while doing something physical.  He said he does get erections with the aid of cialis.  He was diagnosed 14 years ago at 56.  He is now 70.  He told me his PSA was 0.  Just based on reading on this site, there appears to be lots of approaches to treatment.  All appear to have side effects.  I do not claim to know nearly what some of you folks know on this site and I apprecaite your sharing information.  We share a common enemy.  There are a lot of human variables in these equations.  Some are attitude; physical shape; mindset; emotional support.  In most cases, hard to put a statistical value on the human side.  So you listen to the specialists and weigh what they say and move on.  I am in good spirits and at peace with my decision.  I am going to fly the RP plane 3/20/2018.  When I am done with this, I will post how I came out.  

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,769 Member
    MK1965 said:

    Joke of the day

    Grinder,

    ”50% regain potency at 6 months post RARP”

     

    This is the JOKE OF THE DAY!

    i had robotic RP and still 16+ months waiting for sign of life in my deeply comatose non existing penis.

     

    MK

    Why ?

    Why is that "the joke of the day," MK ?

    Your particulars are ancedotal, and therefore do not "disprove" any assertion regarding RP, one way or another.

    max

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,769 Member
    Grinder said:

    Sloppy science

    I do not need to follow up every study you post. If you were doing journal research for a n institute you would be dismissed, because you are looking for research biased to your opinion, and failed to provide the particulars in the first study you quoted, making the quoted content appear to validate your opinion when it did not.

    And... "20% report erections strong enough for intercourse at 5 years of follow up"... again ignoring variables in this study.

    I have no interest in getting into an "I'm right and you're wrong" contest here. I acknowledge that one side effect is 100% of the time... penile shortening. I try to warn everyone who posts in this forum, and the urologists certainly do not inform patients of this side effect.

    But for the sake of accuracy, they need the truth about the ED, and not wholesale condemnation of the RP procedure based on studies quoted out of context.

    Consistent omission

    Another almost universal practice here at this forum when discussing the side-effects of RP is to never mention the side-effect of RT, as if they did not exist.

    A major difference in RP vs RT for PCa is that in PR the side-effects occcur instantly, whereas with RT, they occur later, and gradually.   This undoubtedly makes data recovery of RT effects much less likely to be reported in statistical compilations.

    max