The experience of robotic-assisted laparoscopic prostatectomy

Paddy O’Brien shares his experience of undergoing robotic-assisted laparoscopic prostatectomy (RALP).

Paddy O’Brien (65) lives in Pinelands, Cape Town with his wife. They have two adult children.

Diagnosis

For 15 years, Paddy had a benign enlarged prostate, living with the condition of urgent, frequent urination. In April 2017, a routine PSA test raised concerns. He asked his specialist urologist, who had confirmed the enlarged prostate, about performing a transurethral resection of the prostate (TURP), a surgery used to treat urinary problems that are caused by an enlarged prostate. The specialist agreed, but recommended a needle-biopsy at the same time. The op was performed and as Paddy recalls, “The diagnosis was numbing; 75% of the samples were cancerous.”

Choosing a treatment option

The specialist urologist presented Paddy with two treatment options: brachytherapy, a procedure that involves placing radioactive pellets inside the prostate, or robotic-assisted laparoscopic prostatectomy (RALP).

“He advised me not to make a hasty decision. Although the cancer was advanced (within the prostate he believed), it was not an aggressive cancer. I had time to decide. However, I almost immediately opted for the RALP because it would be a relatively swift way of getting all the cancer eradicated, with the added advantage of probably saving the nerve, leading to a normal sexual life after full recovery.”

Undergoing robotic-assisted laparoscopic prostatectomy 

Before surgery, Paddy made the decision to not know too many details of the operations. “There is a lot of graphic detail, available on the internet, which I simply avoided. 

I trusted my urologist implicitly and just wanted it to proceed. I had a four-month wait for a surgery slot which was a bit hard to accept. So, I said I’d come in at a moment’s notice should there be any cancellations,” Paddy explains.

A slot opened for Paddy on the last day of August 2017. “The pre-op preparations were well-coordinated and I presented myself. The op itself lasted over five hours. I was very excited after regaining consciousness. Especially after being told that as far as could be ascertained all the cancer was removed, as was the prostate, with bi-lateral nerve-sparing. I told family who visited that I was in ‘showroom condition’. 

I experienced no pain or discomfort after surgery. The next day was tough though; the deep anaesthesia had worn off and I felt very uncomfortable. But it wasn’t pain as such, just discomfort. 

I was disappointed with the level of nursing care with food and water being placed out of reach, but that was my only complaint. Soon I was encouraged to walk with the assistance of a physiotherapist and was discharged on day three.”

Use it or lose it

Paddy says the urologist took care in describing the side effects but he was confident that all would be well in due course. “In the early days, I needed pads as I regained urinary control properly. As expected, erectile dysfunction took a bit longer. My urologist’s sound advice was ‘use it or lose it’. That was enough motivation for me to make sure all would be well. And it got better, month by month. After 18-months, I’d say it is all in working order.”

The follow-up procedure was excellent, according to Paddy. “I had post-op visits and checks. All thorough, well-explained and successful.”

Fit and strong

Today Paddy is doing well and keeps himself busy with home maintenance projects and by running a small business. “For my age, I’d say my health is very good. I’m fit and strong. Lockdown has presented its challenges but I’ve done my best to exercise in a limited way. Before lockdown I would go hiking and do long-distance running.”