UPDATE - Issue 36 - Spring 2009
Robotic Surgery - Farewell dear prostate! - Peter Barton’s story
On day 50 following my radical surgery I thought it might be helpful to tell my story particularly for those who may have strayed into USA sites where hugely optimistic claims are made about post operative recovery. Robotic assisted prostatectomies are almost the norm in the USA where they account for 65% of surgeries but are still rare in the UK which has only eight of the fabulous da Vinci robots.
I started my journey in the summer of 2008 when I developed a sudden urinary tract infection. I am a strapping farmer and unused to being laid low by a trivial infection. However, it was serious and put me in hospital for a week, feeling very poorly. The urologist very sensibly did some tests and soon discovered an enlarged prostate and a PSA value of eight that soon led to the inevitable biopsy.
My wife and I were confident that there was little to worry about so it came as a bit of a shock to learn that it was not benign but cancerous with a Gleason score of six and T1c staging. My urologist gently opened up the Pandora’s box of options available to deal with the problem. Each seemed to have several sub offers and an array of side effects and outcomes. The information was, to say the least, confusing.
The look on his face when I asked the inevitable question ‘What would you do in my circumstances?’ told me that even the specialists are placed in invidious positions ‘In view of your age (65) and previous medical history (heart attack and quadruple bypass plus diabetes on insulin), you should consider your own life expectancy,’ he said. ‘Surgery is a major operation, radiotherapy has excellent results but you will still need surgery to deal with the enlarged prostate’.
"The Kegel pelvic floor exercises: they really do work"
Eventually surgery seemed the best personal choice and I was referred to a wonderful surgeon. Yet again I was offered a bewildering array of options – retro pubic radical prostatectomy, laparoscopic, or the new robotic technique.
My surgeon was an expert in the conventional radical. However he was most generous in helping me to be referred to Mr. Chris Ogden at the Royal Marsden, who has considerable experience in robotic procedures.
I was seen quickly and put on a list in just ten days. After a ten hour wait the operation had to be cancelled due to an emergency that left the team exhausted. So I got permission to leave the hospital for the night and return the next day. I can report that we enjoyed a very long dinner at a top restaurant that evening!
The following day I walked down to theatre and was shown the surprisingly large robot that was to get inside me and follow the minute instructions given by the surgeon who operates via remote controls as he views the procedure in 3D at his console in the corner of the room.
I had six tiny incisions in my abdomen through which the microscopic instruments and camera were inserted. My belly was expanded like a balloon with gas and I was tilted at an absurd angle to ensure that all my organs were out of the way.
When I returned to my room some seven hours later I felt fine thanks largely to the dose of morphine I guess. I slept very well and awoke to a full English breakfast. The consultant called in and reported that all had gone as planned and that he would see me in two weeks when the catheter would be removed and the pathology results would be available.
Initially, I found the strange discomfort in my butt upsetting as well as leakage from around the catheter. I left two days after the operation and had to return home via a challenging hour-long train journey.
Recovery at home was swift and I was off all pain relief four days after the operation and able to walk the dog half a mile. However sitting on the incontinence pads became increasingly frustrating, as did the catheter, which was only 85% watertight. After two weeks I hated the catheter with a vengeance and would readily have ripped it out by the time the nurse gently and painlessly removed it.
I then spent a long tiring day trying to get my urinary system to function as it once used to. Strange how you take things like this for granted. I was fortunate to spend the day with another patient who had undergone the same surgery the day before mine and he reassured me that he had had similar experiences.
My surgeon told me that thankfully the margins had all come back negative. That meant that the risk of the cancer spreading to other organs was much reduced. I enquired if this meant that the tumour was a Tiger or a Pussycat and he replied, ‘Leaning towards a Tiger’. In his opinion I had made a wise choice seeking the extermination of my prostate. He asked me to return in three months with a current PSA result that would hopefully be zero.
I returned home again by rail and heavily padded had a rather wet arrival. I spent several weeks searching for incontinence pads that did not cause a major pain in the perineum and can report that Tena for men Level 2 provide a level of safety and comfort that is remarkable. The huge pants with which I was sent home are, in my experience, uncomfortable and unfortunately ruck up into a tight ball in a most delicate area and inflict a very real pain in the arse!
Returning slowly to continence is yet another joy, but not without occasional misery on the journey. After two weeks without a catheter miraculously, I found I was dry all night. My bladder sent out strong and urgent warnings, initially about every three hours. After seven weeks this has improved to perhaps two nocturnal visits.
A most important tip is to stick with the Kegel pelvic floor exercises; they really do work.
All in all I have been pleased with my recovery and a speedy return to something approaching normality. I am now down to one pad per day and one at night for safety. I am playing badminton and squash, swimming and walking. Activities really help rehabilitation but also increase leakage. It has been a tough seven weeks. At times, I wish I had never visited the US da Vinci website where a patient proudly announces he did a full marathon after only four weeks. Post-operative pain in the butt is little referred to in the literature but personally I found it difficult to sit comfortably for much of the time and wooden church pews at Christmas were a nightmare!
Today however the world looks brighter, incontinence is a minor and diminishing problem and as I showered I had the strange feeling that something was stirring in the erectile department. Don’t tell anyone, as they will laugh!
Man, this is a big issue for most of us. We know the risks of surgery and weigh them up carefully. As one friend put it, ‘Would you rather have a great erection or be alive?’
In conclusion, the big debate on the issue of whether to intervene early in prostate cancer still needs to be resolved so that patients can make sensible decisions.
It is little comfort to be told that most patients with prostate cancer will die of something else when reality shows that 10,000 men will die this year in the UK of prostate cancer, not something else!
One third of prostate cancers found are real killers and at present no one can reliably confirm which is which.
I am extremely grateful to the team at The Royal Marsden and feel that my robotic experience has been hugely beneficial. It is available on the NHS as well as privately and I look forward to the funds being provided to make the £1.5 million robots available across the UK together with the associated huge investment in surgical training.
I hope to do a progress report later.