Robotic surgery and holistic treatment of prostate cancer
Prostate cancer is the most common cancer in men in the Western world. Surgical treatment is the most appropriate treatment, provided that the disease and the patient’s other condition allow it. The results of a surgical procedure are considered ideal if excellent oncological exclusion of the disease is achieved, combined with the existence of complete urinary continence and preservation of erectile function.
It is quite possible, however, after surgical treatment of prostate cancer, that problems such as urinary incontinence and erectile dysfunction may occur. For this reason, it is necessary to have a highly experienced and specialized team, that can treat the disease holistically, providing the best results in the treatment of prostate cancer.
Surgical Treatments for Prostate Cancer and Urinary Incontinence
The recommended treatment for prostate cancer depends on the stage of the disease. The most common treatment option is radical prostatectomy surgery, which removes the entire prostate gland and seminal vesicles.
New techniques, especially with the use of robotic surgery, have greatly helped reduce complication rates, while also being virtually painless and offering faster recovery times.
Furthermore, data from recently published studies show that the Retzius sparing robotic prostatectomy technique is superior to all other techniques, whether robotic, laparoscopic, or open surgery, both in minimizing the likelihood of urinary incontinence in the first 6 months after surgery and in the speed of return to urinary continence after removal of the urinary catheter.
With Retzius sparing robotic prostatectomy, the radical removal of the prostate gland is performed through a small incision in the Douglas space. With this technique, we fully respect the anatomical structures surrounding the prostate and minimize the risk of surgical injury to the surrounding tissues (vessels, nerves, sphincter, ligaments, fascia). The result is better results than any other robotic technique in urinary continence, but possibly also in erectile function.
Prostate surgeries & erectile function restoration
It is very important, if the cancer allows it, to completely preserve the vascular bundles of the erection. With complete preservation of the vascular bundles, patients often report erectile function in the first few days after surgery and before they even remove the urinary catheter. However, in cases where either the cancer disease does not allow the preservation of the erectile tissue, or there was some degree of erectile dysfunction before the surgery that worsened after the surgery, it is necessary to have an appropriate and specialized support team for the best possible restoration of erectile function.
The new guidelines recommend protocols for restoring sexual health immediately after prostate surgery and regardless of the severity of the condition. What patients need to understand is that for the period following the surgery, we must keep the erectile mechanism healthy and alive so that the penis does not become inactive. For this reason, we follow specific protocols for restoring erectile function.
There are several options available that can restore erectile function, so that patients can enjoy their sex life without obstacles. Options include oral medication, intrapenile injections, shock waves, and surgical placement of a penile prosthesis.
Early enhancement of erectile function is essential for optimal outcomes, through a holistic prostate cancer management program.
- Rosenberg JE, Jung JH, Edgerton J, et al. Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. Cochrane database. 2020
- Dalela D, Jeong W, Prasad M-A, et al. A pragmatic randomized controlled trial examining the impact of the Retzius sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2017;72:686–688.
- Lim SK, Kim KH, Shin T-Y, et al. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 2014;114:236–244.
- Sayyid RK, Simpson WG, Lu C, et al. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 2017; 31:1244–1250.
- Guidelines for Sexual Health Care for Prostate Cancer 2022
Author
