John J Bauer, MD, FACS John J. Bauer, M.D.
www.flinturology.com

Urology Services, Inc.
G-1121 West Hill Rd.
Flint, Michigan 48507
Tel: 810.232.8888
Fax: 810.232.9190
Email: jbauer@flinturology.com
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Counseling and Pre-Op Note

Patient Name:

Age:

Date:

Procedure: Mini-pelvic lymph node dissection for perineal prostatectomy

Indications:

Patient is a male with a diagnosis of prostate cancer determined with needle biopsy of the prostate performed for an abnormal digital rectal exam and/or an elevated PSA blood test. The pathology report showed the cancer to have a Gleason sum of X + X = X. If the PSA was above 10.0 or the Gleason sum was greater than or equal to 8 the metastatic evaluation of CXR, bone scan and/or CT of the pelvis was without evidence of distant spread. Also discussed was the possible need for a pelvic lymph node dissection as a separate procedure for the above mentioned invasive parameters. This procedure would be recommended if the likelihood of positive nodes was greater than 15-18% using the following equation % = 2/3 PSA + (Gleason Sum ? 1).

Alternatives:

Alternatives to this procedure are laparoscopic pelvic lymph node dissection (PLND), have the radical retropubic prostatectomy where PLND can be done through the same incision or proceed with the perineal prostatectomy and follow serial PSA measurements to determine if there is a persistent PSA then consider adjuvant radiation therapy or hormonal therapy since if the PLN?s are positive removal only incurs a slight survival advantage over any prostatectomy with PLND.

Risks/Complications:

The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.

The specific risks of this procedure include, but are not limited to: small midline scar, lymphoceole, lymph edema of the lower extremities, injury to bladder, ureter, and obturator nerve which will cause inability to move legs to midline and cause a gait disturbance.

You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.

Physician's Signature: ________________________________ Date: __________________

Patient Signature: __________________________________ Date: __________________

Witness: __________________________________