Penile Implant Surgery Miami

Inflatable Penile Prosthesis surgery (Penis implant/penile pump) for refractory erectile dysfunciton

Penile prosthesis surgery (penis implant/penile pump) is an excellent option to regain erectile function in cases of erectile dysfunction refractory to traditional medical treatments such as with oral medications, intraurethral suppositories or injection therapy.  A 3 piece penile prosthesis consists of a pump in the scrotum that allows the user to self inflate and deflate at will with ease, two erectile cylinders placed into the corpora cavernosum (erectile bodies) and a reservoir of fluid located below the abdominal fascia placed through the same single incision.  When an erection is desired, the pump is activated thereby permitting fluid to flow into the cylinders.  The entire device is implanted in the patients body without alteration of the natural body contour.  It would not even be noticable in a locker room.

The 3 piece penile prosthesis (penis implant/penile pump) provides for a natural appearing erection with greater flaccidity when the prosthesis is in the deactivated position as compared to the two piece penile prosthesis or malleable penile implant.  Each prosthesis is custom made to fit the natural size of each individual patient.   The most advanced and up to date AMS penile prosthesis typically placed by Dr. Wirtshafter and Dr. Robbins provides both girth and length expansion.

A three piece penile prosthesis (penis implant/penile pump) is ideal for a patient with refractory erectile dysfunction with adequate manual dexterity and good mental capacity desiring a natural appearing erection with more natural flaccidity than a malleable penile implant or a two piece penile prosthesis .

Penile implant surgery (penis implant/penile pump) is an excellent option for patients with erectile dysfunction and Peyronie’s disease (penile curvature).  In this circumstance, a penile implant can be used to simultaneously correct the curvature and provide excellent erectile function.

Considerations for choosing the appropriate implant include lifestyle, medical conditions, personal preference and cost. As with all surgeries, there are associated risks that include infection, pain and other complications.

Miami urologists Dr. David Robbins and Dr. Amery Wirtshafter have significant experience with penile prosthesis surgery even in complex cases and have helped countless patients to regain their sexual function and confidence.

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PSA Screening Controversy Continues

“The PSA screening controversy continues as government agencies push their cost saving agenda at the expense of the health of every day americans.”  David Robbins, MD

(Reuters) – Dr. Ned Calonge knows firsthand how hard it is to tell Americans they’d be better off with fewer routine medical tests.

A long-time family doctor in Colorado, Calonge presided over the U.S. Preventive Services Task Force, an influential government-backed panel of health experts, when it said that most women under 50 could skip their regular mammograms.

The recommendation two years ago challenged the conviction of many breast cancer patients that they survived precisely because they were screened early. It unleashed a public fury that has weighed on the panel’s deliberations ever since.

“We blew the message,” said Calonge, now president and CEO of the Colorado Trust foundation. “The nuance was completely gone.”

Two men phoned in death threats to Calonge. Protesters showed up by the offices of the government agency that supports the panel, tucked away in a Maryland suburb. The furor slowed down work on a decision to limit prostate cancer screenings as President Barack Obama fought to pass his signature healthcare law and his Democratic party faced a mid-term election challenge in 2010.

“There was a lot of pressure from above to be more careful politically and orchestrate things better,” said Dr. Kenneth Lin, who at the time was an officer at the Agency for Healthcare Research and Quality (AHRQ), a Department of Health and Human Services entity that supports the panel. “Everything with the word ‘cancer’ got shoved back.”

Calonge rotated off the panel this past March after eight years, while Lin quit AHRQ late last year in protest over the delay to prostate cancer screening guidelines that were only released in October. A White House official noted that Calonge has attributed the delay in a final decision on prostate cancer screenings to scheduling conflicts.

Their experience shows just how difficult it will be to curb spiraling costs in the world’s most expensive healthcare system by determining what screenings work, based on a rigorous study of clinical evidence, and what can lead to unnecessary and risky procedures.

“More screening is not always better,” said Dr. Christine Laine, a general internist and editor of the Annals of Internal Medicine who is not part of the panel. “That message is lost in healthcare in general.”

The U.S. Preventive Services Task Force is right on the firing line. For much of its 27-year history, it helped convince millions of Americans to get screened early for disease.

Now the panel of primary care doctors, nurses and academics has reviewed a growing body of research that shows some early screening harms more people than it helps. But it has struggled to convince patients and doctors.

In the wake of the mammogram guidelines, the rate of such screenings for women aged 40 to 69 was barely changed in 2010 compared with 2009, according to the National Committee for Quality Assurance.

“We have a public health measure that we know is effective. Why is it continually being questioned?” said Dr. Carol Lee, breast imaging commission chairwoman at the American College of Radiology.

Graphic on mammograms: link.reuters.com/zuc25s

Graphic on U.S. cancer rates: link.reuters.com/byc25s

BROACHING THE NEGATIVES

The public at large is no less skeptical. A recent Gallup poll showed that nearly 60 percent of Americans believed that standard cancer screenings – including mammograms and prostate specific antigen (PSA) blood tests – were performed often enough. Thirty-one percent thought they should be conducted more frequently. Only 7 percent said they were done too often.

“It’s extraordinarily hard to give up the notion that there’s a way to protect yourself from dying from cancer… Our goal here is to make it a matter of evidence, not a matter of opinion,” said Virginia Moyer, a pediatrician from Baylor College of Medicine, who now chairs the 16-member panel.

“Our successes are measured in positives,” she said of the public’s growing awareness of screening in the last three decades. “We are just beginning to approach the negatives.”

Burned by the experience with mammograms, the task force is looking for a better way to deliver the message, consulting with powerful consumer interest groups, hiring public relations professionals and reworking some of the language tied to its system of letter-based recommendations.

“We’re spending more time paying attention to how we say things to make sure it’s understood well,” said long-time panel member and current co-vice chair Dr. Michael LeFevre, a professor of family medicine at the University of Missouri School of Medicine. “We have no interest in being some wizard behind the curtain.”

The panel now issues its recommendations in draft form first and solicits public comment before making them final. In about a year, the public may have a chance to chime in early on the evaluation process, including posing questions for researchers and reviewing the evidence report draft used by the panel.

Task force officials concede that the comments are unlikely to change the recommended letter grade, unless they introduce crucial new evidence. But they can point to misunderstandings and help the panel better craft its message.

In late October, the panel met with consumer interest groups, including retired persons lobby AARP and the Consumers Union, to get input on how to frame recommendations that was once reserved for patient advocates.

The public’s participation has been unprecedented. The panel is now finalizing its PSA prostate cancer recommendation and public comments on the subject have reached into the thousands, LeFevre said.

WEIGHING THE EVIDENCE

The 2009 mammogram guidance from the task force was based on the panel’s assessment of new research that showed most women over 40 face a 3 percent risk of dying from breast cancer if they have not been screened. Beginning mammogram screening at age 50 and following up every other year reduced that risk to 2.3 percent, compared with 2.2 percent risk starting at age 40.

An extra decade of screening could invite harms such as unnecessary biopsies and tests, the possible treatment of non-deadly cancers and radiation. Women in their forties are also more likely to receive false positive results.

Another view of the data showed that starting screening at age 40 led to 5,000 more mammograms, 500 false positive results and 33 biopsies for every breast cancer death prevented, according to LeFevre.

“If it was just how many deaths do you cause versus how many deaths you prevent, that would be too easy, that would be simple math,” LeFevre said. “We start with somebody who feels well, and we risk making them feel worse.”

The panel voted on a “C” recommendation, which calls for patients to decide on the screening with their doctor. But when the recommendation came out in November 2009, it started with a sentence saying the panel “recommends against” routine mammograms for most women under 50, and that language triggered the controversy.

Under pressure, the task force dropped the phrase “recommends against” a month later. Its rating on mammograms remains a “C.”

The American Cancer Society questioned the evidence, saying the panel focused on gold-standard clinical trials but weeded out newer observational studies that showed better results.

“Screening is not perfect and it’s not error-free, but the question is… do you take protective measures against the unlikely probability that you develop cancer… or do you take your chances?” said Robert Smith, director of cancer screening at the ACS.

That calculation still appears to be guiding doctors, either out of concern of missing an early sign of disease or fear of lawsuits, health experts said.

“Shared decision-making (between doctors and patients) sounds nice, but in practice usually you just end up doing the test,” said Dr. Roger Chou, an internist and researcher at the Oregon Evidence-Based Practice Center. Chou authored the report on prostate cancer behind this year’s task force recommendation.

POLITICAL RUMBLINGS

The heat over mammograms weighed on deliberations over prostate cancer screening. In 2008, the task force gave an “I” recommendation on the PSA test in healthy men under 75, which meant it had insufficient evidence to make a call.

The panel usually updates its recommendations every five years, but new research published in 2009 warranted an earlier evaluation. One U.S. study showed a slightly higher risk of death for men with no symptoms of illness who received a PSA test, while European research showed a slightly lower risk of death.

Although the PSA blood test itself is innocuous, data reviewed by the task force also showed that 90 percent of American men who tested positive got treated, even if they may have been able to forego it, LeFevre said. Out of 1,000 men treated, five would die, 70 would have serious complications and 200 to 300 would be impotent or incontinent.

Given the possibility of false positives in the screening and the fact that prostate cancer can take many years to progress and show symptoms, the question is whether those risks are greater than the risk of doing nothing.

“It looks like your chance of being alive and well is greater if you don’t get screened than if you do get screened,” LeFevre said.

In November 2009, task force members voted on a stronger “D” rating on PSA tests, meaning they recommended against the prostate cancer screening in men under 75.

But the timing was poor as Obama struggled to win over a majority of lawmakers for his healthcare overhaul and Congressional elections loomed large. Once the law was passed in March 2010, it brought more attention to the task force by mandating insurance coverage of services it does recommend.

Republicans opposed to the bill used the mammogram example to show how government could intrude on life or death decisions. The task force’s “C” and “D” recommendations don’t dictate insurance coverage, but Congress quickly turned around legislation to make sure insurers covered mammograms for women in their forties.

“The thought that my work was being use as a fulcrum by one party to kill the most substantial part of healthcare legislation since I’ve been in practice? I’ve got to tell you, that’s something to lose sleep over,” Calonge said.

Officials working with the panel heard that more controversy could threaten the task force budget, up for Congressional approval. In 2010, Health Department funding for the panel was $4.3 million. This year, the agency overseeing the panel spent about $11 million on work related to the task force.

Calonge says the panel wanted more evidence of how the tests could harm healthy patients, and ordered further research. He canceled a new vote on PSA screenings in November 2010, citing scheduling problems, a decision that was widely criticized.

“In my heart of hearts I’d really like to believe that we’d delay it anyway,” without the surrounding politics, Calonge said. “We were trying to make the recommendations solid.”

That was too much for Lin, who believed the evidence was already enough to show the public was at risk. After talking with his pastor and his wife, he quit AHRQ.

“Even delaying it for a few months, much less a year, it was really relegating the men to the harms they were exposed to,” Lin said.

(Editing by Michele Gershberg, Ed Tobin and Claudia Parsons)

Vasectomy Miami

Urological Consultants of Florida’s board certified urologists, Dr. David Robbins and Dr. Amery Wirtshafter have broad experience performing minimally invasive vasectomy procedures and have helped countless numbers of men to achieve voluntary sterility in Miami, Aventura and the sourrounding region.

http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm A vasectomy is surgery to cut the vas deferens, the tubes that carry a man’s sperm from his scrotum to his urethra. The urethra is the tube that carries sperm and urine out of the penis. After a vasectomy, sperm cannot move out of the testes. A man who has had a successful vasectomy cannot make a woman pregnant. Watch this video about: Vasectomy DescriptionVasectomy is usually done in the surgeon’s office using local anesthesia. You will be awake but not feel any pain. After your scrotum is shaved and cleaned, your surgeon will give you a shot of numbing medicine into the area. Your surgeon will then make a small surgical cut in the upper part of your scrotum, and tie off and cut apart the vas deferens. Your surgeon will use stitches or a skin glue to close the wound. You may have a vasectomy without a surgical cut. This is called a no-scalpel vasectomy (NSV). Your surgeon will find the vas deferens by feeling your scrotum and then give you numbing medication. The surgeon will then make a tiny hole in the skin of your scrotum and seal off the vas deferens. The surgeon will usually pull your vas deferens through the tiny hole in order to tie off and cut it apart. You will not need stitches. Why the Procedure is PerformedVasectomy may be recommended for adult men who are sure they want to prevent future pregnancies. A vasectomy makes a man sterile (unable to get a woman pregnant). A vasectomy is not recommended as a short-term form of birth control. The procedure to reverse a vasectomy is a much more complicated operation. Vasectomy may be a good choice for men who: Are in a relationship, and both partners agree they have all the children they want. They do not want to use, or cannot use, other forms of birth control. Are in a relationship, and their partner has health problems that would make pregnancy unsafe for her Are in a relationship, and one or both partners have genetic disorders that they do not want to risk passing on to their children Vasectomy may not be a good choice for men who: Are in a relationship, and one partner is unsure about their desire to have children in the future Are in a relationship that is unstable, going through a stressful phase, or is very difficult in general Are thinking about having the operation just to please their partner Are counting on fathering children later by storing their sperm or by reversing their vasectomy Are young and still have many life changes ahead Are single when they want to have a vasectomy. This includes men who are divorced, widowed, or separated. Do not want, or have a partner who does not want, to be bothered by having to use other forms of birth control during sexual activity RisksThere is no serious risk to vasectomy. Your semen will be tested in the months after the operation to make sure it does not contain sperm. As with any surgical procedure, infection, swelling, or prolonged pain can occur. Careful following of aftercare instructions reduces these risks significantly. Very rarely, the vas deferens can grow back together again. If this happens, sperm can mix with semen. This would make it possible for you to make a woman pregnant. Before the ProcedureTwo weeks before your vasectomy, tell your doctor all of the medicines, even ones you bought without a prescription, vitamins, supplements, and herbs you are taking. You may need to limit or stop taking aspirin, ibuprofen (Advil, Motrin), and other medicines that affect blood clotting for 10 days before your surgery. On the day of your surgery, wear loose, comfortable clothes. Clean your scrotum area well. Take the medicines your doctor told you take. Bring a scrotal support with you to the surgery. After the ProcedureYou should be able to return home as soon as the procedure is done. You can return to work the next day if you do not do heavy physical work. Most men return to work within 2 to 3 days. You should be able to return to your normal physical activities in 3 to 7 days. It is normal to have some swelling and bruising of the scrotum after the procedure. It should go away within 2 weeks. You should wear a scrotal support for 3 to 4 days after the procedure. You can use an ice pack to prevent or reduce swelling. Pain medicine, such as acetaminophen (Tylenol), may help relieve discomfort. You can have sexual intercourse as soon as you feel ready, usually about a week after the surgery. Outlook (Prognosis)Vasectomy does not affect a man’s ability to have an erection or orgasm, or ejaculate semen. A vasectomy does NOT prevent the spread of sexually transmitted diseases (STDs). Your sperm count gradually decreases after a vasectomy. After about 3 months, sperm are no longer present in the semen. You must continue to use birth control to prevent pregnancy until your semen sample is totally free of sperm. Most men are satisfied with vasectomy. Most couples enjoy not having to use birth control. Alternative NamesSterilization surgery male; No-scalpel vasectomy; NSV ReferencesNagler HM, Jung H. Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am. 2009 Aug;36(3):383-90. Update Date: 3/22/2010Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Browse the Encyclopedia

Vasectomy Miami, Florida

Vasectomy

Miami urologists David Robbins, MD and Dr. Amery Wirtshafter, MD are proud to offer patients an office based solution to achieve permanent contraception.

  • What is a vasectomy?
  • Is a vasectomy a good choice for you?
  • How is a vasectomy performed?
  • Myths about a vasectomy procedure
  • What are the real risks associated with a vasectomy?
  • How to prepare for your vasectomy
  • What to expect after your vasectomy
  • Follow up instructions

What is a vasectomy?

A vasectomy is a minor surgical procedure performed in the office resulting in permanent sterility by preventing sperm from exiting the penis during ejaculation.  A vasectomy procedure is minimally invasive and highly effective with success rates greater than 99%. A vasectomy procedure is simple to perform and low risk as compared to a tubal ligation in females and for that reason it is the most popular means of birth control when the goal is to achieve permanent sterility.

Is a vasectomy a good choice for you?

A vasectomy procedure is an ideal way to achieve permanent sterility.  However, the decision to undergo a vasectomy procedure should be taken seriously.  A vasectomy procedure is performed for men that have made the decision that they no longer want to father children.  Although a vasectomy reversal procedure is possible, this is a complex surgical procedure performed in the operating room performed under general anesthesia.  It has a low success rate and is typically not covered by insurance.

How is a vasectomy performed?

Vasectomy works by preventing sperm from reaching your penis.

Sperm is made inside of your testicles.   After leaving the testicles, the sperm travels through an organ called the epididymis where it can mature.   At the time of ejaculation, sperm exits the epididymis though a long tube called the vas deferens into the urethra where it is then mixed with fluid from the prostate and semenal vesicles to create semen.   The semen is then forced out of the urethra via rhythmic contractions of the muscles around the penis and perineum during orgasm.

During a vasectomy procedure, the vas deferens are transected thereby preventing sperm from reaching the penis during ejaculation, thus achieving sterility.  Typically we send a small portion of the vas deferens from each side to the laboratory as confirmation that the vasectomy was performed properly.   Additionally, each side is cauterized and tied with a tiny suture to ensure the intended result is achieved.   There are gimmicky devices on the market which clamp the vas without dividing it which claim to be less invasive, however they do not change the time it takes to perform a vasectomy and certainly do not decrease the risk of complications.   These devices introduce a foreign body into the scrotum which can be uncomfortable and potentially cause infection.

before and after vasectomy

Myths about a vasectomy procedure

Many men are concerned about a vasectomy procedure because they have read on the internet or heard from a friend that it may cause erectile dysfunction or they will not ejaculate after the procedure.   A vasectomy procedure certainly does not cause damage to the nerves that cause erections or cause injury to the erectile bodies.   Erectile dysfunction is simply not a known complication of a vasectomy procedure.  Also, a vasectomy procedure does not lead to decreased ejaculatory volume.  Only a minute portion of the volume of semen in the ejaculate is contributed to by sperm from the testicles.   Greater that 99% of the semen volume is from the semenal vesicles and prostate and the path for these fluids is not changed by a vasectomy.  The volume, color and consistency of semen is not altered by a vasectomy procedure.

Additionally, some patients report that they have heard that a vasectomy procedure may increase their risk for developing prostate cancer.  There is no literature making this connection with statistically significant data and recent studies looking at this concern have shown no connection with vasectomy procedure and prostate cancer.

Finally, It is a common misconception that a vasectomy procedure can affect a man’s libido or ability to achieve orgasm and ejaculate normally.  These functions are definitely not altered by a vasectomy procedure.

What are the real risks associated with a vasectomy?

A vasectomy procedure is considered a safe procedure with few risks especially when performed by a urologist with expertise and experience with the procedure such as Dr. Robbins and Dr. Wirtshafter.

Occasionally minor complications may occur and may include:

  • Pain.
  • Bleeding.
  • Bruising.
  • Swelling.

Very infrequently a post vasectomy syndrome may occur which is associated with prolonged scrotal discomfort.  Typically this can be alleviated with anti inflammatory medications such as ibuprofen and the symptoms should resolve with time.

How to prepare for your vasectomy

A vasectomy procedure is typically performed in our North Miami Beach or Miami Beach office under local anesthesia.   The vasectomy procedure takes about 15 minutes to perform and is tolerated very well by our patients.  To add to patient comfort during a vasectomy procedure, we prescribe Valium to be taken 1 hour prior to the procedure.  Additionally, we recommend to patients that they bring an ipod or personal music player with earphones to make their vasectomy experience more relaxing. With the combination of a Valium and music, it is common for patients to fall asleep during the vasectomy procedure.

Before your vasectomy:

  • Clean and shave your scrotal area.
  • Avoid taking anti-inflammatory medicines like ibuprofen or Aspirin.
  • Wear tight-fitting underwear to your vasectomy appointment.
  • Bring someone to drive you home after surgery.

What to expect after your vasectomy

After a vasectomy, it is important to avoid strenuous activities such as exercise heavy lifting or sexual activity for 3-5 days.  It is typical to have mild discomfort that can be relieve with Tylenol or ibuprofen.

Ice should be applied to the area indirectly for 20 minutes every few hours while awake for the first day to reduce swelling and discomfort.

A topical antibacterial such as Neosporin or Bacitracinshould be applied to the wounds 2-3 times per day for several days.

It is important to avoid submerging the wound in water such a in a bath or swimming pool.  These activities can allow bacteria to enter the wound and lead to infection.  It is OK to take a shower even the day of the procedure, but the area should not be washed vigorously or scrubbed with a brush.

Since you will be taking Valium, it is important that someone is there during the procedure and available to drive you home.

Immediately following vasectomy, there is a slight risk of bleeding into your scrotum.  Contact your doctor if you experience:

  • Significant swelling in your scrotum.
  • Intense pain.
  • Fever.
  • Redness in the scrotum.

Follow-up Instructions

A vasectomy procedure is not immediately effective.  There are still sperm that are left in the vas deferens beyond the point where the tube is divided.  These sperm are viable and capable of causing an unplanned pregnancy. Effective birth control should be resumed after the vasectomy procedure until a negative semen analysis is documented and confirmed by Miami urologist Dr. David Robbins or Dr. Amery Wirtshafter.

A semen analysis should be performed 2 months after the procedure and it is important to have at least 12 ejaculations prior to the analysis to clear the tubes of any remaining sperm.

For the first day or two after vasectomy you may experience mild discomfort in your scrotum or abdomen.  Over-the-counter medications such as Tylenol should help. The doctor may also send you home with narcotic pain medication.

Urological Consultants of Florida vasectomy forms

Miami urologists Dr. David Robbins and Dr. Amery Wirtshafter have provided a pdf copy for download of the vasectomy consent form that you signed at the Miami Beach office or the North Miami Beach office.  You can additionally download the post vasectomy instruction form below.

Vasectomy consent

Vasectomy Discharge Instructions

Please click on the link below to contact Miami urologists Dr. Amery Wirtshafter and Dr. David Robbins for further information or to schedule an appointment.

                            SCHEDULE AN APPOINTMENT

DISCHARGE INSTRUCTIONS FOLLOWING VASECTOMY

LEAVING THE MIAMI BEACH OR NORTH MIAMI BEACH OFFICE:
1. You will need to have someone take you home following the surgery
WHEN YOU GET HOME:
1. Stay off your feet as much as possible for the next 12 hours. This will reduce the chance
of scrotal swelling.
2. Wear cotton, JOCKEY undershorts for increase support and comfort.
3. Avoid heavy lifting or vigorous exercise for seven (7) days after surgery.
4. You can shower the day after surgery. Avoid rubbing the scrotum when drying.
5. Sexual activity can begin one week after your vasectomy when scrotal swelling and
tenderness subside
6. CONTRACEPTIVE PRECAUTIONS ARE ABSOLUTELY NECESSARY UNTIL THE SEMEN
ANALYSIS PRODUCES NEGATIVE RESULTS.
7. Eight to Twelve (8‐12) weeks after your vasectomy, you need to do a Semen Analysis.
8. Please call our office immediately if you have any post op complications including:
a. Infection
b. Bleeding
c. Increasing pain
d. Swelling
e. Temperature of 101
9. If you have any questions, please call the office at (305) 944‐0025.

Androgen Deprivation Treatment for Prostate Cancer

“This article below brings into light new new insights into the cardiovascular risk associated with androgen deprivation therapy for prostate cancer.”  David Robbins

ADT May Not Be Linked To Increased Risk Of Death From Cardiovascular Causes.

The Los Angeles Times (12/7, Roan) “Booster Shots” blog reports that “a prostate cancer treatment called androgen deprivation therapy [ADT] has been somewhat controversial because of fears that the medications involved may raise the risk of death from cardiovascular causes,” but research published in the Journal of the American Medical Association “did not find that association.” Investigators “looked at eight randomized clinical trials on” androgen deprivation therapy.

Bloomberg News (12/7, Flinn) reports that investigators “examined the results of eight trials of 4,141 patients with prostate cancer that had spread beyond the gland.” The researchers found that “eleven percent of patients on the therapy died from heart disease, compared with 11.2 percent in the control group, an insignificant difference, according to the report.” Bloomberg News adds, “In a further analysis of 4,805 patients from 11 trials, about 37.7 percent on the medicines died, compared with 44.4 percent in the untreated group.”

HealthDay (12/7, Reinberg) reports, “‘The use of hormone therapy and radiation is of benefit for patients,’ said Dr. William Kelly, a professor of medical oncology and urology at Thomas Jefferson University’s Kimmel Cancer Center in Philadelphia and co-author of an accompanying journal editorial.” For “this study, the benefits of hormone therapy outweighed the risks, Kelly said.” But, “he noted that these were selected patients in clinical trials, not patients in the general population, in which sicker patients might be at risk for cardiovascular events from hormone therapy.”

WebMD (12/7, Boyles) points out that “just over a year ago the FDA warned that” the “treatments may increase the risk for fatal heart attacks in prostate cancer patients.” And before that “warning, health groups — including the American Heart Association, the American Cancer Society, and the American Urological Association — issued a joint statement designed to alert doctors and patients about the therapy’s potential risks.” Also covering the story were Reuters (12/7, Pittman), the Boston Business Journal (12/7, Donnelly, Subscription Publication), and Medscape (12/7, Nelson).

Robotic Prostate Surgery for the Treatment of Prostate Cancer

What is da Vinci Prostate Cancer Surgery?

Prostate cancer surgery has been revolutionized with the use of the da Vinci robotic surgical system. Da Vinci Robotic Prostatectomy is a minimally invasive option for prostate cancer treatment available thanks to cutting edge breakthroughs in surgical technology. Da Vinci robotic prostate cancer surgery maintains all of the benefits of definitive surgical treatment for prostate cancer while adding the benefits decreased blood loss, less pain and more rapid return to regular activities and a shorter hospital stay.  For these reasons it is clear why da Vinci robotic prostate cancer surgery has become the preferred method for removal of the prostate after early diagnosis of prostate cancer.

About Dr. David Robbins

Miami urologist David Robbins, MD is a board certified urologist and is the director of the robotic surgical program at Urological Consultants of Florida. He has a special focus in prostate cancer having trained under the guidance of world renowned prostatectomy surgeon and pioneer in the field of nerve-sparing prostate cancer surgery Dr. Herbert Lepor. He refined his techniques of nerve-sparing prostatectomy for prostate cancer during his time at NYU and is now recognized by his colleagues and patients as one of the best prostate cancer surgeons performing da Vinci robotic prostatectomy surgery in greater Miami region. Dr. Robbins is currently performing da Vinci robotic prostate cancer surgery on a weekly basis with excellent results with respect to maintenance of erectile function, urinary continence and most importantly cancer cure. Dr. Robbins is currently perfoming da Vinci robotic prostatectomy procedures for prostate cancer at Mount Sinai Medcial Center in Miami Beach and Aventura Hospital and Medical Center in Aventura.

Why Choose Dr. David Robbins?

Miami urologist Dr. David Robbins trained at New York University and learned how to perform robotic surgery from world leaders in the field of prostate cancer surgery and da Vinci robotic surgery. This specialized training in robotic prostate cancer surgery along with Dr. Robbins’ intense drive toward improvement has helped him to develop the skills necessary to provide patients with the highest quality robotic surgery outcomes espcecially with regard to prostate cancer cure, urinary continence and maintenance of erectile function. In addition to patient satisfaction with the functional aspects of robotic prostate cancer surgery, Dr. Robbins is highly appreciated by his patients for the personal care that he delivers and his genuine compasion. For these reasons, Dr. David Robbins is considered by many to be the best urologist specializing in robotic prostatectomy surgery and prostate cancer treatment in Miami, Florida.

Why Robotic Surgery?

During open “radical” prostatectomy (removal of the prostate) for prosate cancer, the prostate is removed using a large midline incision from the umbilicus to the pubic bone. The major drawback of this approach is not only the size of the incision but also the stretching of the abdominal muscles and skin that is necessary to place a retractor to gain the appropriate visualization in order to perform an open prostatectomy. This large incision can take longer to heal and results in increased post operative pain and impaired mobility. One of the many advantages to da Vinci robotic prostatectomy for prostate cancer is that is can be performed through five tiny incisions and the prostate removed through the umbilicus at the end of the procedure. This leads to less post operative pain and scarring and a quicker return to regular activities. Additionally, the view of the surgical field afforded by the 3D stereoscopic display means that the surgeon has a much clearer view of the nerves and blood vessels surrounding the prostate which helps to minimize blood loss and reduces the risk of damaging the nerves responsible for continence and erectile function. During da Vinci robotic prostatectomy for prostate cancer, the prostate gland and seminal vesicles are separated from the bladder and urethra and then these two structures are reconnected over a foley catheter to maintain a contained urinary channel. For advanced disease the pelvic lymph nodes can be sampled to verify that the disease has not spread beyond the prostate.

What is the “robot”?

The robot itself consists of two units. The Patient-side cart has four robotic arms for carrying out the surgery; one arm holds a camera and the other three hold instruments. The surgeon sits at a console with a stereoscopic 3D view of the operating field. Unlike a conventional (2D) screen, this allows the perception of depth which makes accurate surgery much easier. Beneath the display are the master controls which translate the surgeon’s hand movements in real-time to the movement of the robotic arms and instruments. The system is designed to remove tremor and allow very precise movement.

Patient Testimonials

“I was diagnosed with prostate cancer in November 2010. On February 15, 2011, I registered at Mt. Sinai Hospital for robotic surgery to be performed by Dr. David Robbins and his team. Deep inside, I was expecting the worst. These were the results: 1) Pain – No pain (Percocet was prescribed. Didn’t have to use any). 2) Overall Discomfort – The same night of the surgery I walked the hallway on my hospital floor. 3) Incontinence – After the catheter was removed I used pads for a few days. Not saying that every once in a while I got a little wet, but three weeks after the surgery it was 95% under control. Today, fine and dandy. I thank the Good Lord for delivering me into the gifted hands of Dr. Robbins. An event that causes so much distress because of the obscure, turned out to be a positive, very bearable life changing experience.” DR. ROBBINS’ EXPERT ROBOTIC TEAM Please click here to download and print a copy of Dr. Robbins preoperative and postoperative instructions for da Vinci robotic prostatectomy. Please click here to link to additional information from Intuitive Surgical regarding da Vinci robotic prostatectomy.

Prostate Cancer Surgery Miami

“This is another article which highlights the debate over PSA screening for prostate cancer.  It seems that although the US Preventative Task Force has decided unilaterally to recommend against PSA screening, government officials including President Obama and Senator Wyden have chosen to ignore the recommendations and have their PSA screened.  Senator Wyden additionally underwent surgery after being diagnosed with prostate cancer.”  David Robbins

The politics of prostate cancer

  • Sen. Ron Wyden walks to the Senate floor on Capitol Hill. | AP Photo
Sen. Ron Wyden chose surgery for prostate cancer over ‘active surveillance.’ | AP PhotoClose
By DIANE WEBBER | 12/21/10 4:40 AM EST

Sen. Ron Wyden had surgery for prostate cancer Monday, putting himself — through no fault of his own — in the middle of a debate about diagnosis, treatment and bending the cost curve.

The longtime health care advocate and Oregon Democrat was operated on by Alan Partin at Johns Hopkins Hospital in Baltimore. The cancer was caught early, and Wyden, 61, has an excellent prognosis, according to his office.

The option known as “active surveillance” (formerly “watchful waiting”) allows patients to avoid or delay surgery, radiation and chemotherapy — and the side effects that come with those treatments. Active surveillance means coming back to the doctor on a regular schedule for a blood test and examination to see if the cancer is growing. But few men choose it.

Wargo discusses active surveillance with her patients, and she considers it a good option for those who fear surgery or have other serious health problems. She is on board with the new nomenclature. “Watchful waiting sounds like you can just go disappear and not come back to see me,” she said. But she understands why many men choose surgery. “There is a personality of men who can’t live with the idea that there is something inside them that could kill them.”

Bruce Quinn, M.D., health specialist with Foley Hoag and a former official in California’s Medicare program, pointed out that, over a five-year period, active surveillance doesn’t save significant funds, because the slow-growing cancers often become aggressive and require more expensive, invasive treatment.

“It’s not the difference of $100 versus $30,000 if you look at the cost comparisons over five years. Active surveillance is more costly than people think,” said Quinn. “It’s not popular, I think, because patients must find it pretty uncomfortable to be told they have a 2-to-3-centimeter tumor that could eventually blow up and kill them, and we’re just going to watch it. Men say, ‘Just get the damn thing out!’”

Wargo and Quinn both noted problems with the prostate-specific antigen test that is the screening tool used for diagnosis. A normal level in one individual might be abnormal in another, and doctors need to track changes in the level over time to approach any kind of accuracy.

“You really have to look at each patient individually,” said Wargo. “A PSA level of 4 is normal in an older patient, but it is completely unacceptable in a 47-year-old. You can have a low level and still have aggressive prostate cancer.”

Complicating matters is the fact that no test accurately predicts who will get the aggressive, deadly form of the disease and who will get a slow-growing, non-life-threatening form. Quinn points to Medicare reimbursements as part of the problem.

In choosing surgery over what used to be called “watchful waiting,” Wyden took a path that many men take when faced with a prostate cancer diagnosis. But increasingly, that path is questioned in the era of health care reform, as cost-cutting is pitted against personal choice.

Doctors acknowledge that the cost-cutters have a point but bristle at the intrusion into the physician-patient relationship.

“It is well and good for statisticians to say, ‘This is the patient who doesn’t need to be treated,’” said Heather C. Wargo, a urologist practicing in Mount Laurel, N.J. “But when I am sitting with a patient, looking him and his spouse in the eye, it is very difficult to say, ‘I’ve been accused of overtreating, so I’m not going to treat you.’”

The U.S. Preventive Services Task Force, the body that sparked a firestorm when it said that most women do not need an annual mammogram until age 50, was set to vote on new prostate-cancer-screening recommendations last month. Instead, the panel canceled its November meeting, citing “scheduling conflicts.”

Kenneth Lin, professor and family physician, quit the task force in protest. “Politics trumped science this time, as it has in the past, and may at times in the future,” Lin wrote in his blog, where he linked to a news account of the mammogram controversy.

Rep. Debbie Wasserman Schultz (D-Fla.), who had breast cancer, told POLITICO that the task force “seems out of touch with reality.”

“I think that organization really undermines its credibility, not necessarily among the scientific community but for the general public,” Wasserman Schultz said, noting that there were no cancer experts on the panel when the breast-cancer-screening recommendations were made.

Yet statistical analysis like the task force’s research has some of the greatest potential to save money on health care spending.

Prostate cancer is ripe for study. Researchers question whether it is being overdiagnosed and whether too many surgeries are being performed on tumors that would never become dangerous.

“The Medicare fee schedule is around $20 for the PSA test, and it is just frozen there,” said Quinn. “It’s really hard for companies to do the trials that they need to do to come up with a more effective, more precise prostate cancer test with this artificially very low fee.”

Mara Aspinall is CEO of On-Q-ity, a company working on new diagnostic tests that have the potential to identify rare cancer cells circulating in the bloodstream, long before they are prevalent enough to be picked up as tumors on MRI and CT scans.

Aspinall said the Medicare fee schedule is a problem for her new technology. “In the laboratory, the more steps your process has, the more you’re paid,” she said. “This was a useful construct some time ago, but it has not kept pace with technology. We now can have one really big step to replace 10 small ones. It’s an incredible disincentive.”

While Aspinall argued that better diagnostic tests could bring more clarity and potential cost savings to prostate cancer treatment, she emphasized that tests can’t replace the doctor-patient dialogue.

“It is essential that the decision on how to proceed — even in the era of diagnostics — needs to continue to be an educated discussion between the physician and the patient,” said Aspinall. “We want to bring more information to the equation.”

Wyden will no doubt be helpful in bringing more information to the equation as he recovers from his disease. He started working on public health issues as a young lawyer when he founded a legal aid society for the elderly and Oregon’s first chapter of the Gray Panthers. During health care reform, he was the architect of the Healthy Americans Act, which would have radically changed health care from the employer-based system, and now he is co-sponsoring a bill that encourages states to innovate on reform implementation.

“If anything is taken away from my experience, I hope it is the importance of getting routine physicals,” Wyden said as he was disclosing his disease last week. “One in six men will be diagnosed with prostate cancer during their lifetimes. Early detection is critical to catching this disease when treatment is most effective.”