Nerve Sparing Prostate Surgery recommendations

[Maddog2Blues]

Does anyone have a recommendation for a surgeon that is known for their nerve sparing technique? My understanding is that there are only a handful of these surgeons . Many thanks.

[Tall_Allen]

Since the 1980s, when Walsh invented the technique, every surgeon tries to do it. It is a relative term - preservation of the neurovascular bundles can range from complete sparing to non-sparing or anything in between, depending on what the surgeon finds when he opens you up. I think frozen sections with a pathologist standing by is a good idea, although many urologists don't do that. Even with complete nerve sparing, the rate of preserved potency in men who were previously fully potent is 35%.

[Handdrummer777 in reply to Tall_Allen]

That is a shockingly low percentage, considering they were potent going in.

I'm glad I chose radiation, but it has its own pitfalls, RiED, etc. I'm crossing my fingers that I'm not going to have downstream ED.

The Giddy is coming out too late for when I started ADT. But I think it's going to become the default go-to device for ED worldwide.

[Tall_Allen in reply to Handdrummer777]

What is RiED?

[Handdrummer777 in reply to Tall_Allen]

Radiation-induced ED

[Tall_Allen in reply to Handdrummer777]

it usually shows up within 9 months post-RT

[Handdrummer777 in reply to Tall_Allen]

Hmm...this is month 9 post-RT and month 13 for ADT. Holding steady so far by virtue of using the Loop to get reliable erections. I worry about decreasing sensitivity, but that happens anyway as we age. My ADT began in June 2018, so it was too early for the Giddy (will still buy!).

But again, that Loop (and daily 5mg tadalafil, and mentally propping up libido to an extent), have all done what they were supposed to: hold the line pretty well against penile deterioration.

[Hidden]

You might want to research HIFU.

[Adf2529]

Where are you located? How far will you travel?

Recommend looking at teaching institutions with high volume/ experience.

[Murph256]

Dr. Vincent Laudone at Memorial Sloan Kettering in Manhattan. He only does robotic assisted surgery on the DaVinci Surgical System. He performs 250 surgeries a year. He’s been doing it for 12 years. And he has a great bedside manner.

mskcc.org/cancer-care/docto...

[CalBear74]

Dr. Patel in Orlando Florida is one of the best in the southeastern United States.

[Wade-o]

Dr Vipul Patel is one of the best in the country, if not world. Like Tall Allen said, everybody is going to be different depending on what he finds when he opens you up. I believe age has a lot to do with also. I was 50 yrs old when Dr Patel did mine and after 3 months full sexual functions returned and almost fully continent, only 1 pad a day when I’m at work.

[Handdrummer777 in reply to Wade-o]

Fantastic results! You beat the 3-1 odds to stay potent after RP.

[TB2G]

I've heard that Dr. William Catalona at Northwest Medicine in Chicago has performed over 7000 prostatectomies, and he also was involved in pioneering nerve sparing surgery. He does his open.

G

[cesanon in reply to TB2G]

1. I have heard some unkind things about Catalona's post surgery bedside manner.

2. I understand he no longer does surgery or does it so much.

You should go talk to him personally before making a decision. I think at this point in the history of robotic surgery, I would prefer some of the younger surgeons, all of whom were trained on robots as opposed to the old ways.

[Mjex]

Vincent Laudone at Sloan Kettering. He spent almost 4 hours peeling off nerves for me and I had cancer outside the capsule. I am pleased to report that it was time well spent.

[cmaseo in reply to Mjex]

I’m currently being followed at MSK. When did you have your surgery? Any ED? How long did urine problems last?

[Mjex in reply to cmaseo]

Surgery in Sept 2014. Wore pads for about 6 weeks. Since then a drop now and then if I am tired or drinking. I was able to resume sex as soon as the catheter was out with help from Viagara. Of course I was 69 at the time so nothing works as good as when it was new. Salvage radiation the following year, not great for sex but didnt stop me. Lupron for 2 stretches of 9 months slowed me a bit, but in the off periods it was back to normal, like every other day. I cannot say enough good things about the drs and staff at Sloan Kettering. They are great.

[cmaseo in reply to Mjex]

That’s great to hear. I’m currently wondering which doc t go with for the surgery. There’s no official yelp ratings so it’s all about work of mouth.

Thank you for sharing.

[toml77]

More important to concentrate on no spreading and incontinence than nerve sparing in my opinion.

[bw1963]

Here is the link to my surgeon if you are in this area. Awsome with thousands under his belt. He does the open procedure. I couldn’t haven’t ask for a better doctor.

surgery.duke.edu/faculty/ju...

[Hidden in reply to bw1963]

have an appt with Dr. Moul in a few weeks.

[tkalaf]

I had my RP in June 2018, and am pleased with the results. My urologist/surgeon is well regarded in this area. Here is a link: uwmedicine.org/bios/william...

I wish you the best!

[JoelT]

What is important is that the surgeon be at a high volume institution and ALSO that the surgeon is high volume and has a set team in the operating room. Best outcomes and less side effects will be obtained by docs who have the most experience.

[cesanon in reply to JoelT]

That is the best rule to follow. Pretty much for all medical care and procedures.

[PKLA]

Check out Dr. Claus Rhoerborn at UT Southwestern Medical Center in Dallas, Chief of Urology since 2002. When I had my RP, nerve sparing in May, this year, he had done about 2500 of these procedures. In my opinion, he's a rock star!

[AllFixed]

Dr. Sverrisson @ Dartmouth Hitchcock, Lebanon NH

[cesanon]

If you want to spare nerves, look into SBRT radiation treatment.

[TB2G]

Who s your surgeon Bob?

[Maddog2Blues]

Thank you everyone for your comments. I am in the process of pursuing surgery with Dr Vitul Patel in Florida.