Detroit, MI (PressExposure) October 01, 2009 -- The physicians and researchers at the Vattikuti Urology Institute continuously examine techniques and results to ensure we deliver the best possible care to patients.
Two earlier publications from the Vattikuti Urology Institute have provoked a great deal of interest among patients and urological surgeons. The first, published in European Urology, and the second, published in the American Cancer Society's medical journal Cancer, provide a comprehensive analysis of the Vattikuti Institute Prostatectomy (VIP). In 2008, these papers were cited by more than 150 authors.
We operated on more than 2,700 patients between 2001 and 2006, and collected data on patient #1 through patient #2766. The Cancer study represents the most comprehensive analysis of the largest series of patients undergoing robotic surgery, with the longest follow-up, anywhere in the world.
How did our patients do?
The news is very encouraging. Our patients, by and large, came to us with moderately aggressive prostate cancer (70 percent with a Gleason 7 or above). Yet, very few patients died of prostate cancer -- 2 out of 2,766. However, we are realistic and understand that number may grow over time. What may that number be? The first sign of a cancer recurrence is the presence of PSA in the blood (or "PSA recurrence"). Even using a very strict definition of PSA recurrence, only 7 percent of patients had a detectable PSA in the blood and in only 1 percent of patients did the PSA continue to rise. Therefore, the death rate from prostate cancer in patients undergoing the VIP may be as low as 1 percent over 15 years.
If cancer cure is pretty much a given, what about functional effects?
More than 95 percent of our patients were continent within 12 months. About 4 percent had to wear pads; some of these men leaked just a few drops of urine and chose to change pads frequently, for purposes of hygiene. At 12 months, 2 percent of men leaked enough urine that they had to use two or more pads a day. Less than 1 percent of patients had little to no urinary control.
How about erectile function?
Before surgery, the overriding concern in most of our patients was cancer cure. Then after surgery, it became erectile function. This is a good sign because it means that these men considered themselves to be cured of cancer. Overall, 80 percent of men who were potent before surgery, and had interest in sexual activity, were able to have intercourse within 12 months. However, not all of the patients in these studies underwent the Veil of Aphrodite nerve-sparing procedure.
Was erectile function better preserved in men who had the veil type of nerve sparing developed at the Vattikuti Urology Institute?
Yes. When we looked at men with normal erectile function who underwent the veil nerve sparing and had a willing partner, 93-97 percent had erections strong enough for intercourse. More than 70 percent of men were back to normal sexual activity, 50 percent without medications and 20 percent with medications such as Viagra Â®, Cialis Â® or Levitra Â®. Another 20-25 percent of men were able to have intercourse even though the strength or frequency of their erection was not the same as before surgery. These men were not taking any medications, mostly because they felt that the medicines did not help.
The Veil of Aphrodite procedure was developed at the Vattikuti Urology Institute based on the belief that some men have nerves hugging the side of the prostate and that the more nerves you preserve, the better erectile function will be. Earlier studies have suggested that this was indeed the case, but these patients were selected carefully. As we became more confident about cancer cure, we started to do the veil nerve-sparing technique more often. As of now, we try to do it in most of our patients with normal erectile function.
What about men who did not have the veil operation, but had conventional nerve sparing?
About three-fourths of the men were able to have sexual intercourse with the help of medications. However, less than 20 percent of men were back to normal function without medication.
What is the bottom line?
Our VIP operation is highly effective for treating prostate cancer, and the vast majority of men can expect to be cured of their disease. Most men regain full urinary control within 2-3 weeks after surgery. In pre-operatively potent men who underwent the veil type nerve sparing, and continued to be interested in sexual intercourse, more than 90 percent were able to accomplish this, using medications as needed. More than 70 percent of men considered their erectile function to be normal. About 7-10 percent were impotent, and the rest were able to have intercourse, but perceived their erections as not being as strong as before surgery.
How has this research helped advance robotic prostate surgery?
The results of these studies were achieved without a structured erectile dysfunction program. Patients were simply asked to take erectile dysfunction medications if they felt they needed them. None of these patients were treated with injections or a vacuum device.
Since the conclusion of these studies, we have performed the nerve sparing procedure more frequently. We also introduce medications, injections or the vacuum device in the early post-operative period, while waiting for nerve function to return.
We assess urinary function at four months and recommend a procedure to tighten the urinary muscle in patients who are leaking more than one ounce of urine a day.
We continue to refine the VIP procedure and, looking forward, we anticipate even better results than those reported in these articles.