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What Causes Lymphedema Post Laparoscopic Radical Prostatectomy?

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Posted on Mon, 30 Mar 2015
Question: davinci robot assist laparoscopic radical prostatectomy, with bilateral pelvic lymph node dissection, nerve sparing ---surgery was performed on me on 9 july 14. pronounced a success, I returned to some semblance of normalcy and was able to discard the depends about 2 mos.ago. Achieving erection is possible is possible with trimix solution and a syringe, but the outcome wasn't too good. spent 2 nites with priaprism, one time in the ER to get the antidote. haven't tried it since. sex was not a big part of my life , starting to drop about 2009 for relationship problems & lack of testosterone.

that, however, is not current problem. I seem to have developed a case of lymphedema. the edema started around late fall of 2013, was intermittent in nature, sometimes almost disappeared, was told to do the usual fixes, no salt, etc. Heart checks out , no venous insufficiency, however it lingered on, annoyingly. fast forward to nov. or dec. of 14. legs below knee got bigger , sking tighter, was cracking, feet very large. all this complicated by plantar fasciitis both feet. diagnosed with lymphedema around 1st of February. have seen PT , couple of visits, was told to stop taking diuretics, blew up this past week and I am back on them .
my wife works at a cancer center and she talked to an oncologist who I went to last year for a second opinion before the surgery. she talked to him yesterday and wanted a copy of the surgeon's operative notes. I picked them up today. I swear the doctor told me that all cancer was confined to prostate AND that he took biopsy of lymph node, which proved to be negative. I have had 3 or 4 PSA's, all of them 0.00 to date. oncologist , without seeing operative report is of opinion that lymph node was messed with. I am giving him report today. he is saying that because of the report of possible and likely lymphedema diagnosis.
operative report list under procedure: RALRP, WITH BILATERAL PELVIC LYMPH NODE DISSECTION, NERVE SPARING..

My question: Did surgeon do work on lymph node up to & include removing it based on the above statement? I was told lymph node was only biopsied AND I WAS TOLD that ALL CANCER WAS CONFINED TO PROSTATE..
doctor
Answered by Dr. Manuel C See IV (26 hours later)
Brief Answer:
Review the histopathology report.

Detailed Answer:
Good Day and thank you for being with Healthcare Magic!

It would be better to see also the histopathology report to see the number of lymph nodes that was removed. It would say if the surgeon did a sampling of lymph nodes or did a full pelvic lymph node dissection.

I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://www.HealthcareMagic.com/doctors/dr-manuel-c-see-iv/66014 I would gladly help you. Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manuel C See IV (17 hours later)
DID YOU NOT GET THE UPLOAD OF THE OPERATIVE REPORT? WHAT MORE DO YOU NEED TO KNOW ABOUT THE BILATERAL PELVIC LYMPH NODE DISSECTION? IT TOOK YOU THAT LONG TO GET BACK TO ME AND YOU WROTE 2 PARAGRAPHS? YOU ANSWERED THE QUESTION WITH A QUESTION. TO ME, IT SOUNDS LIKE A DOCTOR COVERING UP FOR ANOTHER DOCTOR. OK., ON MONDAY, I AM GOING TO CALL THE CLINIC AND ASK FOR A HISTOPATHOLOGY REPORT JUST FOR YOU! IF SUCH A REPORT EXISTS I WILL UPLOAD IT TO YOU. THEN MAYBE YOU CAN ANSWER MY QUESTION. HOW ABOUT THAT?
THANK YOU. ERNIE SVITES.
HONESTLY, I GOT MORE INFORMATION OUT OF A FIRST YEAR MED STUDENT THAN I GOT OUT OF YOU. I AM VERY VERY DISAPPOINTED.
doctor
Answered by Dr. Manuel C See IV (7 hours later)
Brief Answer:
Thank you for getting the histopathology report.

Detailed Answer:
I am very sorry you feel that way and you are dissatisfied with my answer. But honestly that is the only way to know if your doctor did just lymph node sampling or a complete lymph node dissection. If you base it on the operative record then yes he may have done a complete lymph node dissection, but if he said that he only sampled the LN then he may just placed LN Dissection for insurance purposes. We will know once you have provided me with the histopathology result.

Also I don't see the above mentioned operative report. You may upload it again. Thank you.

Regards, Manuel C. See IV, M.D. DPBU FPUA
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manuel C See IV (48 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Manuel C See IV (19 minutes later)
Brief Answer:
Small number of LN harvested.

Detailed Answer:
Thank you very much for exerting effort in getting this report. Incan safely say now that your doctor did only node picking and not a complete lymph node dissection. If your doctor did a complete dissection then the number of lymph nodes should reach on the average 15 or more.

Regards, Manuel C. See IV, M.D. DPBU FPUA
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Manuel C See IV

Urologist

Practicing since :2005

Answered : 909 Questions

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What Causes Lymphedema Post Laparoscopic Radical Prostatectomy?

Brief Answer: Review the histopathology report. Detailed Answer: Good Day and thank you for being with Healthcare Magic! It would be better to see also the histopathology report to see the number of lymph nodes that was removed. It would say if the surgeon did a sampling of lymph nodes or did a full pelvic lymph node dissection. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://www.HealthcareMagic.com/doctors/dr-manuel-c-see-iv/66014 I would gladly help you. Best wishes