Robot prostate operation that saves patients from leaky bladder

Prostate cancer patients could soon escape debilitating incontinence thanks to a pioneering robotic operation.

The procedure would be life-changing to the four out of five men who experience leakage after having their prostate removed. Patients often have to wear pads following the existing invasive op, leaving many afraid to leave the house.

But according to a new study, the robot surgery can slash the risk of severe incontinence. It is designed to avoid long-term damage to the urethra – the urine tube which runs through the pancreas.

Research shows that injuries to the urethra are one of the leading causes of incontinence.

Until now, only patients at University College London Hospital (UCLH) have been able to access the procedure, called radical robot assisted prostatectomy with complete urethral preservation, as part of a pilot project.

However, experts say it will now be rolled out at hospitals across the NHS. They say it will also lower the risk of erectile dysfunction, a common side effect of prostate removal.

‘The results are remarkable,’ says Professor Greg Shaw, a cancer specialist at UCLH. ‘Men are coming back after the procedure not needing any pads, which is unheard of. The surgery even appears to help more men get back to being sexually active.’

Prostate cancer is the most common form of the disease in men, with 52,000 new diagnoses every year. It occurs in the prostate gland, the walnut-sized organ which sits below the bladder and produces semen. The disease kills around 12,000 every year.

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The majority affect men aged over 65 and tend to be slow moving. Many patients will never require treatment because the disease does not threaten their health. However, some will need chemotherapy, radiotherapy or tablets to slow its spread.

Around 8,000 have their prostate removed every year in the UK as a result of cancer, in a procedure known as a radical prostatectomy. 

Ordinarily, this involves cutting the prostate and urethra in half. Once the prostate has been removed, the cut ends of the urethra are stitched back together. However, this often shortens the length of the urethra, which research shows raises the risk of urinary incontinence, where patients cannot control their bladder movements.

In 2019, actor and comedian Stephen Fry, 67, revealed he had been forced to rely on incontinence pads after he had prostate cancer surgery the previous year.

The new robot-guided technique involves making the cut along the length of the urethra. This means the urethra is dissected but the length does not change. Once the prostate is removed, the tube is stitched back together. 

Results from the pilot study involving nearly 100 patients found that six weeks after the operation 60 per cent of patients had no problems with urination – meaning it halves the incontinence risk.

Experts say the procedure can easily be adopted across the NHS. ‘This will be easy to roll out as it doesn’t require surgeons to learn a new technique from scratch or hospitals to require new equipment,’ says Professor Shaw.

‘I have already taught this to five other surgeons, and we can expect more patients to benefit from this soon.’

One patient who has already benefited from the pioneering surgery is father-of-two Udall Evans, 47, from London. 

Udall, who works in the film industry, was diagnosed last year after a blood test taken as part of a routine GP check-up suggested signs of cancer. Hospitals scans revealed he would need urgent surgery to remove his prostate due to the size of the tumour.

‘I was quite concerned about the side-effects,’ Udall says. ‘I’d been told it could last months but I didn’t really have a choice.’

Rather than receiving the standard operation he was offered the new procedure at UCLH in June.

The robot op was successful and Udall was home the next day. ‘The team prepared me with sanitary pads anyway but I didn’t really have any leaking,’ he says.

‘I was able to lead a normal life. It has been such a relief.’