The findings of an NYU Langone Medical Center questionnaire were recently published in the Journal of Urology, indicating that one in eight men experience climacturia, defined as sexual incontinence or the leaking of urine during sex and climax, following open prostate surgery for the treatment of localized prostate cancer. Dr. David Samadi is a robotic prostatectomy expert and Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, who believes different post operative results would be seen with a “broader statistic sampling including patients treated by different surgeons performing open, as well as robotic, prostate surgeries.”
The questionnaire polled 1,459 patients of Dr. Herbert Lepor’s from 2000 to 2007. The responses showed that one in eight men are experiencing urinary incontinence during sex and 36% of those polled said the problem persisted two years after surgery. Even some men with normal urinary control during the day indicated a degree of incontinence during sex. All respondents underwent traditional, open prostatectomy surgery at NYU to remove a cancerous prostate.
The American Cancer Society estimates that more than 240,000 men will be diagnosed with prostate cancer in the United States this year. Of those men, approximately 90,000 will undergo radical prostatectomy surgery as their treatment of choice. Dr. Samadi praises those men by saying, “Without a doubt, the best course of action is to remove the prostate and remove the cancer. Radical prostatectomy is the number one way to ensure elimination of prostate cancer and allow men to move on with their lives worry-free.”
Dr. Samadi stresses, however, that the method of radical prostatectomy and the surgeon chosen have a significant impact on a patient’s results. Men have three surgical choices for the removal of their prostate: open prostatectomy, during which the surgeon removes the prostate in a traditional open surgery, laparoscopic prostatectomy or robotic laparoscopic prostatectomy.
Dr. Samadi cautions that open prostatectomy surgery, which was performed on the patients of this questionnaire, has its limitations. “Patients often experience longer, more painful hospital stays with open surgery; there is more blood loss. More blood in the operating field means less visibility, so the surgeon must rely on touch. This can increase the potential for damage to vulnerable areas such as the sphincter and tissue under the pubic bone.” Dr. Samadi continues by saying that laparoscopy offers some advantages over traditional surgery, but that robotic surgery makes great leaps in improving the surgical experience for both patient and surgeon. “Robotic prostatectomy provides significant advantages. Blood loss is minimal and the robot provides 3D sight with magnification up to 10x. So as a surgeon, I can really deal with the prostate and the cancer in a way that previous methods couldn’t provide. If I can see, I don’t need to touch, so the risk of trauma is reduced. And the enhanced dexterity is critical to my surgical technique.”
Dr. Samadi explains that his own SMART (Samadi Modified Advanced Robotic Technique) surgery offers two significant advantages. He works to maintain urinary incontinence by, “not suturing the dorsal vein complex at the beginning of surgery. This allows me to control the length of the urethra, and the more urethra I can leave intact, the greater the patient’s resistance to incontinence and leaking after prostate surgery. Fewer sutures means less trauma, and the risk of damage to the sphincter is minimal.” Robotic surgery also limits the time a catheter is needed after surgery to about a week; further reducing trauma and discomfort. Dr. Samadi continues by explaining how his SMART surgery can preserve a man’s sex life, “I don’t open the endopelvic fascia during surgery, so the tissue surrounding the prostate remains intact. This tissue contains the nerves critical to sexual function.”
Eight-seven percent of his patients regain sexual potency within 12 to 24 months after prostatectomy and 97 percent regain urinary control within two to three months. “I do worry that releasing the results of questionnaire such as this one may scare men. I’m very honest with my patients about the potential side effects of prostate removal. Pre-surgery counseling is very important. But, I also believe I can help mitigate negative side effects with robotic surgery using my SMART surgery technique. Men have to make the decision that’s right for them. I urge them to gather all the facts before making their prostate treatment decisions,” he says. Further, Dr. Samadi does not dismiss the need for a solid foundation in traditional surgical methods. “The best robotic surgeons have a strong background in traditional, open surgery and a significant volume of experience in laparoscopic and robotic surgery. Drawing on the knowledge and skills of all three is key.”Press Releases