Urology in Germany is a privileged discipline, which has achieved excellent results in combating cancer. Cancer centers and clinics in Germany are excellently equipped and offer the whole spectrum of new methods for efficient cancer treatment. If you have been diagnosed with prostate cancer, your physician will recommend surgery in which the gland will be removed entirely, provided that the tumour is limited to that organ alone, and no metastasis has developed. Usually, metastasis is ruled out by means of ultrasound, X-ray computed tomography or magnetic resonance imaging and a bone scintigraphy. With these procedures, changes to the bone can be detected in the early stages. These examinations usually take place on an out-patient basis.
There are several different options for the treatment of prostate cancer via surgery. First, a decision is made as to which operative access route is the most suitable for your prostate cancer surgery. One option is the radical retropubic prostatectomy (RRP) which requires an incision in the lower abdomen. Another option for prostate cancer surgery is radical perineal prostatectomy, which requires an incision in the perineum (this is the area between the anus and the scrotum). The disadvantage of this type of prostate cancer surgery is that the lymph nodes cannot be removed during this procedure.
In the case of a very low PSA count, the surgeon might decide not to remove the lymph nodes. Alternatively, they must be removed laparoscopically in a second procedure. Current studies indicate, however, that lymphadenectomy (laparoscopic prostatectomy) plays an important role in the patients' chances of recovery after prostate treatment. It ensures the removal of all the cancerous tissue in the case of micrometastatic disease, thereby raising the chances of recovery of patients who might otherwise not have survived, despite having had prostate cancer surgery.
Other methods of prostate cancer surgery include laparoscopic techniques and robot-assisted operations. For these procedures, 5 relatively small incisions are made in the skin (1-2cm) and a camera is inserted into the patient’s body. The prostate cancer surgery is then performed with special laparoscopic instruments. The disadvantage of this type of surgery is that the surgeon only has a two-dimensional screen view of what he is doing. A great deal of experience is also required in order to achieve results that are comparable to standard open prostate cancer surgery.
Some of the disadvantages associated with a laparoscopic operation are ruled out by the da Vinci operating procedure. In the da Vinci method, two robotic arms perform the actual prostate cancer surgery, but the entire procedure is controlled by a skilled surgeon via a console that is not necessarily situated within the operating theatre. A special camera-monitor system also generates a three-dimensional picture of the operation area. Studies have shown that the results obtained by the da Vinci method are comparable to those of open prostate cancer surgery.
The most commonly used prostate cancer surgery method world-wide is a radical retropubic prostatectomy. The Friedrichshafen Clinic has been using this as a routine method for many years. We continually improve and advance our methods in line with international standards. The operative access route has been miniaturised. Whereas a long incision from the navel downwards was previously used, a small incision of only 8-12cm is now sufficient. No muscles are cut in this procedure – the incisions are made along the muscular fascia – the areas that connect the muscles.
The surgeon works through special wound protectors that protect the edges of the open wound from damage by the surgical instruments. This also prevents the severe blood loss that was unavoidable previously. In many clinics, the transfusion rate is from 30 to over 50%. At the Friedrichshafen Clinic, the likelihood of a patient needing a blood transfusion during prostate cancer surgery is approximately 5%. As a result, we no longer require the patient to give blood in case we need it during his operation.
Another side-effect of prostate cancer surgery used to be the destruction of the erectile nerves. This resulted in impotence after the procedure. In the last 10 years, a technique has been developed, whereby an experienced surgeon can avoid damaging the erectile nerves, which run along the inside of the prostate capsule. However, this is only possible in patients in whom the tumour has not yet reached the edges of the prostate gland. These nerves are very fragile and can easily be damaged by manipulation.
For this reason, surgeons at the Friedrichshafen Clinic in Germany now perform this procedure with special magnifying glasses that magnify the surgeon’s view of the operation area 4 or 5 times. This increases the chances of the nerves withstanding the procedure without damage. If the nerves on both sides of the prostate are spared, 60 to 90% of patients retain their erectile function.
Due to the low rate of complications, the period of hospitalisation after prostate cancer surgery has been reduced. Generally patients can leave the hospital 5 days after the operation. The catheter, which is essential until the urethras have healed, can usually be removed after 10 days.
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