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: Radical perineal prostatectomy with or without nerve sparring techniques

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 include watchful waiting, radiation therapy (external beam and radioactive seed placement), cyrotherapy, and hormonal therapy. Surgical options are retropubic or perineal prostatectomy. Retropubic operation or Perineal with separate PLND was recommended over perineal only procedure for the higher likelihood of LN positivity.

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: impotence, incontinence, urinary tract infection, bladder neck contracture, rectal injury which may be severe enough to require a fecal diversion procedure with a colostomy and then future reattachment of the colon, fecal incontinence, loss of ejaculatory function, change in the character or loss of orgasm, chronic pain of the epididymus or testicle, additional procedures may be required in 30% of patients for incontinence that include: urethral bulking agents; male sling; or artificial urinary sphincter placement, 50-80% for impotence to include: oral agents; vacuum tumescence devices; penile injection therapy; intraurethral agents; and or penile prosthesis placement, 5% for bladder neck contracture to include: bladder neck incision; dilation therapy and laser ablation of the stricture, positive surgical margins or seminal vesicle invasion potentially requiring adjuvant radiation therapy or hormonal therapy.

Additionally, even though rare, there could be nerve injury (neuropraxia) from the lithotomy position and prolonged surgery time such as sciatica or lower extremity nerve damage resulting in loss of sensation and motor disturbances. These are usually transient, however, there could be chronic residual defects. Muscle necrosis (myonecrosis) could also occur causing Myoglobinurina and transient renal failure. This is also transient and may require an extended ICU stay with dialysis until renal function returns.

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: __________________________________