Patients and the ProPep Advantage
Nerve monitoring has been the standard of care in numerous surgical procedures for over two decades — radical prostatectomies aren’t one of them. For patients to stand the best chance of pre-operative levels of urinary continence and sexual function after prostate surgery, they must ask their surgeons to use nerve monitoring or find a surgeon who does.
What is nerve monitoring?
Nerve monitoring is putting sensors in or on the patient that identify and monitor electrical signals conducted by nerves. The aim of nerve monitoring is to provide nerve location information to the surgeon during an operation. This way, surgeons have a better understanding of nerve pathways that can potentially be damaged as they perform the operation. Nerve damage may result in serious, permanent consequences, and nerve monitoring is required for spinal cord surgery and ENT surgeries. But nerve monitoring is perceived as optional during robot-assisted radical prostatectomies (RARP). Surgeons can paralyze a patient if they don’t use nerve monitoring during spinal surgery, just as easily as they can leave a man incontinent or with sexual dysfunction if they fail to employ it during radical prostate surgery. This is because somatic nerves necessary for proper urinary and sexual function are not visible, and in most cases, can only be detected with nerve monitoring.
Whereas nerve monitoring has been an integral part of spinal cord, brain and maxillofacial surgery for over 20 years, it is still underemployed in radical prostate surgery. Nerve monitoring only became the standard of care for spinal surgery, however, after lawsuits from unhappy patients.
Where we are today
Currently, nerve monitoring technology provides additional, real-time information to even the most experienced surgeons, helping them make important judgement calls during RARP prostatectomies. Unfortunately, despite its success in other surgical specialties, many patients are still not offered nerve monitoring as part of their prostate cancer treatment plan. The reason they are not aware of this technology is because urologists are focused on the main purpose of the prostatectomy: to remove the cancerous tissue. Additionally, a patient’s definition of continence means having urinary control as he did before surgery – a urologist’s definition of continence may often mean using up to two pads per day. It is important to understand these differences in order to have realistic expectations following treatment.
For a patient, their urinary and sexual functions after post-operative recovery (which directly impacts their quality of life and mental health) are almost as crucial as being cancer-free. It is no wonder, therefore, that some men regret choosing to undergo a radical prostatectomy: not only are urologists unintentionally setting high expectations through their definitions of continence and sexual function, but surgeons aren’t utilizing all the available tools – namely, nerve monitoring technology – that help ensure the best patient results. The reason why nerve monitoring is so important is because it helps surgeons preserve nerves crucial to these functions, providing the best chance for a full recovery and return to quality of life for patients after surgery.
The future standard of care
There’s still a long road ahead for making real-time nerve monitoring technology the standard of care for radical prostatectomies. However, the first steps have been taken, with many experienced urologists across the United States already using ProPep, a real-time nerve monitoring solution used in conjunction with the da Vinci system for RARP surgery. When patients have one surgical outcome in mind, but surgeons have another, it is up to patients to demand alternatives to current prostatectomy practices. And if the surgeon refuses, it is absolutely within a patient’s rights to switch to a surgeon who will operate using nerve monitoring technology. Requesting and advocating for nerve monitoring is how this much-needed change will come about — and the power to make this happen lies with the patients. It starts with asking your surgeon to use nerve monitoring.