Johannesburg - The two biggest fears for men about to have prostate cancer surgery are incontinence and erectile dysfunction.
But a relatively new surgery technique has lowered the rate of impotency from surgery in a number of men.
This is according to Dr Hugo van der Merwe, a urologist at the Urology Hospital in Pretoria.
Van der Merwe said that not only did this technique decrease the incidence of impotence in patients, it also led to a shorter hospital stay and faster recovery.
They employ robotic surgery using the Da Vinci Surgical System which was first brought into the country in 2013. The delay in bringing in the equipment – which first-world countries have been using since 1999 – has been an economic one as the system costs R20-million.
There are only four such systems in the country – one at the Urology Hospital, another at an institution in Midrand, and two in Cape Town.
Van der Merwe said that before robotics, some men suffered from impotence, incontinence and a long and painful recovery. But now, due to the precision of the surgery, vital nerves may be preserved more easily.
“It is important to stress that the system is just an enabling technology and a form of minimally invasive surgery. Initially, these types of surgeries were done via the open technique, cutting into the abdomen. Then came laparoscopic surgery, but its equipment had certain limitations.
“The robotic surgery gives the best of both worlds, giving a 3D view with the advantage of being minimally invasive and delicate.”
With the Da Vinci Surgical System, surgeons operate through just a few small incisions, it features a magnified, 3D, high-definition vision system and tiny, wristed instruments that can bend and rotate at far greater angles than the human wrist.
But the surgeon is still the one operating the system and performing the surgery.
“People have a misconception that the surgeon drinks coffee while the machine does all the work. No. It’s an enabling equipment. So for prostate surgery, we make one large cut, and five smaller incisions, and because these incisions are smaller and separate, the cut heals easier and with less complications.
“It’s a lot less painful and there’s a lot less blood lost.”
So far, 700 patients have been treated at the hospital in Pretoria using the system.
Dr Lance Coetzee, also from the Urology Hospital, said in a statement: “Previously, potency may have returned – sometimes only partially – over a period of one to two years with an average 50 percent recovery rate.
“Now we’re seeing erectile function often returning within one to three months, depending on the patient’s potency before the operation.”
He explained that previously, some men chose to live with prostate cancer, maintain potency, and die from the disease, rather than undergo an operation and risk becoming impotent.
“Now this is no longer necessary,” he said.
But it isn’t cheap, and Van der Merwe said medical aids were only just warming up to covering it on their schemes.
“Initially when we started the treatment, we had quite the resistance from medical schemes, but now there has been a turnaround.
“Some medical aids pay half for the treatment and the patient then has to make a co-payment.”
WHAT IS PROSTATE CANCER?
Prostate cancer occurs in a man’s prostate – a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.
The prostate lies just below the bladder in front of the rectum. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body).
Prostate cancer is one of the most common types of cancer in men. It usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm.
While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Prostate cancer that is detected early – when it’s still confined to the prostate gland – has a better chance of successful treatment.
SIGNS AND SYMPTOMS
There are no warning signs of early prostate cancer. Once a tumour causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:
l A frequent need to urinate, especially at night.
l Difficulty starting or stopping a stream of urine.
l A weak or interrupted urinary stream.
l Leaking of urine when laughing or coughing.
l Inability to urinate standing up.
l A painful or burning sensation during urination or ejaculation.
l Blood in urine or semen.
* Sources: www.webmd.com/prostate-cancer/; www.mayoclinic.org and www.cancer.gov/types/prostate
The Star