Obsession with Post-Prostatectomy Continence Drives New York Urologists Back to the Future
--Team Hones Four-Handed Sensory-Guided Open Surgery Technique as Alternative to Much Heralded Robotics --
New York, NY (May 27, 2008) With hundreds of prostate surgeries performed over the past 20 plus years to their credit, Drs. Eugene Fine and Irwin Leventhal, two of New York's most respected prostate surgeons have honed a precision approach to prostate surgery that results in what they contend is a superior rate of continence -- achieving between a 90%-95% success rate where there is no urine leakage. This, against a backdrop of an incidence rate of over 230,000 cases of prostate cancer in the U.S. each year and a tsunami of editorial media attention and advertising advocating the technology behind what is commonly referred to as robotic surgery.
The Fine and Leventhal Continence Preservation Prostate Surgery Technique employs a team-approach (involving at least two senior surgeons)of precisely synchronized, well choreographed surgical steps that benefit from direct tactile and visual sensory feedback which the doctors explain can only be achieved with an open-surgery, hands-on procedure that is complimented by in-surgery dialogue.
Specifically, to achieve their outstanding continence rates, Drs. Fine and Leventhal focus extraordinary attention and surgical skill at the point of the prostate/bladder junction - the narrow space between the patient's bladder neck and prostate gland.
Together, the surgeons, through visual examination and by employing their four hands, identify the optimal cleavage point between the bladder and the prostate and gently "tease" them apart to assure the best possible opportunity to preserve the bladder neck in its natural state when the prostate is removed
Through this procedure, Drs. Fine and Leventhal reduce the risk of compromising the bladder neck that must remain intact to assure continence optimization - with a zero tolerance for leakage. The benefit of the Fine-Leventhal Continence Preserving Prostate Surgery Technique is that the patient's own circular fibers at the bladder neck are preserved, allowing for a tight seal, usually immediately - while the patient is still on the operating table.
In contrast, robotic surgery slices into the general area of the junction of the bladder and prostate without the ability to feel for the cleavage between the two and exposing the optimal area for separation. To compensate for this, robotic surgeons often use a row of stitches to create a new bladder sphincter and seal.
Sometimes this procedure does not create a tight enough closure to prevent urine leakage in normal circumstances and, more often, this procedure results in a high incidence of leakage under stress conditions. Post surgical reporting data underscore that robotic surgery requires a much longer recovery time to achieve continence - - sometimes months versus immediately or within a few days with Drs. Fine and Leventhal's Continence Preservation Surgery Technique.
It is the lack of sensory feedback and the resulting lack of precision, inherent in laparoscopic prostate surgery, especially around the area of the bladder neck that Drs. Fine and Leventhal feel can result in a greater number of continence issues as well as other serious concerns.
For instance, according to Stacy Loeb, M.D. and William J. Catalona, M.D., in their paper "Laparoscopic or Robotic Prostatectomy - Not There Yet", in the Quest Newsletter,2006, "Overall, laparoscopic and robotic prostatectomy have not been shown to significantly improve potency, continence, or anastomotic leak rates as compared to open surgery. And they go on to point out that nearly all laparoscopic or robotic surgeons have adopted a bladder neck-sparing approach to avoid having to reconstruct the bladder neck. Because it is more difficult to identify the bladder neck laparoscopically, the laparoscopic bladder neck sparing approach carries a greater risk for leaving prostate tissue behind on the bladder neck and may increase the risk for positive surgical margins, both of which can cause troublesome postoperative elevations of PSA levels". According to Drs. Fine and Leventhal, this can result in the recurrence of cancer. "Our goal is to achieve a cancer free patient with a high quality of life," says Dr. Fine. "Maintaining urinary continence is, for most patients, the most important consideration as they explore their prostate surgery options. Our team approach gives our surgical patients the best chances of success at living a normal, healthy life," he says.