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A selection from
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
by Patrick C. Walsh, M.D., and Janet Farrar Worthington
page 208
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radical retropubic prostatectomy. It's no exaggeration to say that the
operation used to be performed in a sea of blood. In this era, many
men believed that the side effects from surgery were almost worse
than having the disease. So understandably, when radiation treatment for prostate cancer was introduced in the 1960s and popularized (see Chapter 9), doctors as well as patients welcomed this alternative therapy. Although doctors realized that it probably did not cure prostate cancer as well as surgery, it certainly had fewer side
effects.
The harshness of the procedure and its after-effects were the catalysts for change, inspiring the anatomical discoveries that have drastically reduced these side effects. As a result of these discoveries,
when radical prostatectomy is performed by an experienced surgeon,
most men should remain potent, and few men should have serious
problems with urinary control. Today, radical prostatectomy is the
most certain way to cure men with cancer that's confined to the
prostate.
Grafting a kinder, gentler, better operation: How did radical
prostatectomy change? My role in this operation began in the early
1970s. Like many urologic surgeons, I was appalled by the blood loss
in these men. With the goal of finding surgical methods to lessen the
bleeding - so we could actually see what we were doing instead
of blindly feeling our way - I studied the anatomy of the venous
drainage surrounding the prostate, and developed some new techniques, which did two things: First, with less bleeding, the operation
became safer. And with what we call "a bloodless field," critical structures - which previously had been unrecognized and damaged,
simply because there was too much blood in the way - could be
looked for and saved. More precise dissection and reconstruction
reduced the likelihood of significant urinary incontinence to 2 percent, and even those 2 percent are not incontinent all the time. (We're
still working to improve this - more below.)
Breakthrough in Understanding Potency
But what about impotence? It had been widely assumed that
penile nerves inevitably were damaged by the radical prostatectomy.
Previously, many doctors thought the nerves that controlled erection
ran through the prostate and would be destroyed as a necessity if you
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