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Prostate surgery hits sexual function

10th January 2012

Older men should be careful before considering robotic prostate cancer surgery, according to a recent US study.


In robotic prostate surgery, also known as robotic-assisted laparoscopic prostatectomy, a surgeon uses a tiny robot to access the prostate, making waypoints by piercing the belly at intervals.

The researchers found that the surgery tended to affect men's sexual functioning in the vast majority of cases.

The treatment has caught on rapidly, despite the lack of evidence that it actually works.

Urinary leakage was also just as common as sexual problems, as a side effect.

Matthew Cooperberg, of the University of California in San Francisco, a urologist who co-wrote an editorial accompanying the study, said that, to an extent, the problem lay with the manufacturer, and to an extent with the surgeons.

He said that US culture tended to put great faith in technology, even when the patient didn't understand how that technology worked.

For the new study, researchers simply polled about 600 prostate cancer patients, all of whom belonged to the same healthcare system.

About 400 of those people had robotic-assisted laparoscopic prostatectomy.

All of the other patients had traditional open surgery, involving the total removal of the prostate gland.

The researchers found that, statistically speaking, all of the people who had one of the types of prostate surgery seemed to fit into the same bracket.

Men who opted for robotic surgery, however, did have a slightly more frequent occurrence of urinary problems.

Nine out of ten men who had robotic-assisted laparoscopic prostatectomy reported sexual problems following their surgery.

Cooperberg said that the problem revealed by the recent paper had to do with the expectations patients had about their operations.

Cooperberg and his colleagues wrote that the robot was impressive technologically, since it allowed the surgeon to sit at a console and direct the robot using magnifications and 3D vision.

The robots themselves cost several million dollars per unit, and do have some advantages.

One advantage of using the robots is that there is less blood loss than with the direct removal of the prostate.

Cooperberg said that the success of operations was highly dependent on the skill of the surgeons involved, and that patients should be asking their doctors about track records, rather than focusing on technologies.

Otis Brawley, chief medical officer of the American Cancer Society, said that he would not be afraid to go interview doctors, and that he felt people should go with their gut feelings about whom to trust, realising that every doctor they interviewed would be trying to present the best possible appearance.

He said that operations in people with early-stage prostate cancer might not need treatment at all.

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