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72. (From “101 Aphorisms, adages, and illustrations for the urological resident.”)

A Silk Purse out of Sow’s Ear

When it comes to advising a patient to have an inflatable penile prosthesis placed, you’d better make sure it is the last resort. I don’t care how hard, or not hard, they push you to skip to that treatment option. You should you use the neurosurgeon’s technique of making it very clear that “We are operating on your back because conservative measures have not worked and I can make no guarantees regarding outcome” or “This procedure destroys the natural ability of the penis to get erect; you can’t go back once we do this.”
But this is only the start. You see, some patients think that the prosthesis makes things bigger. You can say it ten times but they don’t hear it and they don’t hear that the head does not engorge and the girth will be less. Initially, you should try to talk them out of it because there is no wrath like the impotent man scorned. If they persist, know the downside risk and that you are only promising a firm penis and that is all, you may want to proceed. Make sure they know about the potential for prolonged post-operative pain after insertion. Oh, and don’t forget that there may be an infection and that the prosthesis may need to be removed and if removed, you may not be able to put another one in. And since the cavernosa are now sclerotic, “happy days” will not be here again.
After all this and every “I” is dotted and all “Ts” crossed, you successfully put in the prosthesis and you are now showing the patient how to cycle it up a month later. It turns out the patient has poor hand to eye coordination, and this is a task that he can’t master in one office visit. But even now, this isn’t the kicker.
“Doc, my penis was much bigger than this before you put this in. I bet it is at least an inch and half shorter,” he says as his wife, who is in the room as well, nods in agreement.
Rule: You can make a penis firm; you can’t make a purse from a sow’s ear.

IMG_3591

Fog of war

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Do your research to take the fog out of the decision making!

Ps…that should be a lake behind Penelope.

John McHugh M.D.:

Designer diapers?

Originally posted on Prostate diaries:

don't punish a child for bed wetting....even the lowliest of animals will not sleep in their own urine.... don’t punish a child for bed wetting….even the lowliest of animals will not sleep in their own urine….

I ‘m the one in the blue diapers- When it comes to prostate cancer treatment decisions the likelihood of cure is only one of the factors to take in consideration. ps…I made the diapers out of the corner of the envelope the card came in….clever huh?

Prostate Cancer Treatments Often Cause Side Effects

05 Feb 2013

Prostate Cancer Study Tracks Long-term Urinary, Sexual and Bowel Function Side Effects Following Therapy

A new study comparing outcomes among prostate cancer patients treated with surgery versus radiotherapy found differences in urinary, bowel and sexual function after short-term follow-up, but those differences were no longer significant 15 years after initial treatment.

The study, led by first author Matthew Resnick, M.D., instructor in Urologic Surgery, Vanderbilt University Medical Center, was published in the Jan. 31 issue of…

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John McHugh M.D.:

This Gleason’s is not funny!

Originally posted on Prostate diaries:

From the ASC Website

Finding and treating all prostate cancers early may seem like a no-brainer. But some prostate cancers grow so slowly that they would likely never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all — it would never have lead to their death or even caused any symptoms. But they may still be treated for these cancers, either because the doctor can’t be sure how aggressive (fast growing and fast spreading) the cancer might be, or because the men are uncomfortable not having any treatment.

I have read many times on various respected organizations websites that “doctors don’t know which prostate cancers are slow-growing and which are fast growing. Granted there are some Gleason 6’s by virtue of their location at the seminal vesicles that act aggressively…but in general…

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John McHugh M.D.:

Thoughts on post prostatectomy incontinence.

Originally posted on Prostate diaries:

What is the internal sphincter in regards to the male bladder, post prostatectomy incontinence and the external sphincter?” Hmmmmmmmmmm? If the internal sphincter is so important to continence then why don’t men leak after a TURP?

Dr. Catalon’s explanation of post prostatectomy anatomy and continence.

There  was  a comment about the internal sphincter and a patient being disappointed that the urologist did not tell him that it would be removed at the time of a prostatectomy. The patient has incontinence and is concerned that if the internal sphincter had not been removed he would not be leaking urine.  Here are my thoughts and my understanding of continence after the prostate is removed..

But first….Walsh’s take on this matter…on in which I am in full agreement.

  • The external sphincter is a defined muscle that one can contract and stop and start the urinary stream.
  • It is the primary sphincter for the control…

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John McHugh M.D.:

If all you have is a hammer… The whole world is a nail

Originally posted on Prostate diaries:

Question:

I am 63 years old and in good health.  I was recently diagnosed with prostate cancer (Gleason 6; low volume; TIC Stage 2).  My urologist–a surgeon–went through the options with me and my wife.  He also stated that he felt I was a prime candidate for using the new trueBeam radiation method (45 treatments).  He set me up to meet with radiology oncologist.  I also have an appointment with a surgeon he recommended that performs the daVinici Robotic surgery.  After reading your book and the Johns Hopkins book, I was leaning towards the surgery — the “gold standard.”  Now after meeting with the radiologist, many of my fears and concerns relative to radiation were “debunked.”  Do you have any insight or could you direct me to any studies relative to the trueBeam radiation therapy?  Treatments would be done less than six miles from my home — a real plus.

From the…

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