Robotic Assisted Radical Prostatectomy (RARP)
Surgeons often claim certain advantages over radiation and other non-surgical options:
1. Examination of the surgically removed prostate allows for accurate staging, enabling doctors to make rational decisions regarding the need for further immediate treatment right after surgery. (This argument was stronger prior to the advent of modern MRI, targeted biopsies and PSMA Pet scans).
2. Surgery provides relief of obstructive voiding symptoms from BPH by getting the prostate “out of the way of the bladder.”
3. Hormone therapy with TIP will not be necessary (unless after the operation a new, unsuspected degree of cancer spread is detected).
4. The accuracy of PSA monitoring for relapse is better after surgery than after radiation and other non-surgical options.
5. Salvage therapy to the prostate fossa (for local recurrence in the fossa) is usually feasible after surgery.
RARP generally takes between one and a half to three and a half hours. Thirty to sixty additional minutes are required when the lymph nodes are removed. After the operation, men wake up with a catheter that protects the new connection between the urinary bladder and the urethra. Most men will be able to go home from the hospital the following day. The catheter is removed a week later. Most can return to work within 2 to 3 weeks.
Preventative measures improve the likelihood of recovering erectile function including regular doses of Viagra. In addition, Men who want to be proactive and for men who are having zero erections should start injection therapy. A small amount of medicine is injected with a tiny needle directly into the penis several times a week. It is analogous to diabetics giving themselves insulin. With the correct dose, a full erection will result within about 10 to 15 minutes and last about an hour. These injections keep the penis healthy while the nerves are waking up. It will also allow the patient to have intercourse.
In terms of urinary recovery, twenty-five percent of men experience immediate return of complete bladder control. Fifty percent have no need for pads by 6 weeks; 85 percent are dry by 3 months; and 90 to 98 percent by one year. Results are influenced by a patient’s age, preoperative bladder control, prostate size and the nerve-sparing technique used. In the few men who do not regain urinary continence, medical therapy can sometimes be successful.
ABOUT THE AUTHOR
Timothy Wilson, MD is a board-certified urologist who specializes in minimally invasive, laparoscopic, and robotic-assisted urologic oncology. He is one of the top six surgeons in the world, in terms of volume, that performs robotic-assisted laparoscopic prostatectomy. Dr. Wilson is a member of the American Urological Association and the Society of Urologic Oncology. Throughout his tenure that spans nearly 30 years, he has published numerous peer-reviewed articles and book chapters in the areas of urologic oncology, urinary reconstruction, and robotic surgery. In 1995, Los Angeles magazine deemed him one of 25 “Doctors who are making a difference,” and in 1998, he was voted “Professor of the Year” by urology residents in training at the University of Southern California School of Medicine.