Pouchomarx, I still had the j-pouch when I had the prostatectomy.
I found Dr. Kaouk through my research for a surgeon. A major concern for me was the large amount of abdominal scar tissue from all the pouch surgeries. A lot of surgeons won't perform a prostatectomy if you have a j-pouch. That's how I learned about Dr. Kaouk. Dr. Kaouk uses a newer DaVinci robot that can bypass abdominal scar tissue using a transvesicle procedure. It’s a single-port robot rather than the established five-port DaVinci. You can Google both Dr. Kaouk and this technique for more detailed info. Basically, a three-inch incision is made beneath the navel and then Dr. Kaouk manipulates the DaVinci through the incision, then through the bladder to reach and remove the prostate and seminal vesicles. No scar tissue gets in the way and there's quicker healing with the one small incision.
I liked Dr. Kaouk as soon as I met him. I had confidence in his approach, in the single-port transvesicle procedure, and more importantly in his skill. He did tell me upfront that ED was a high probability (60%), and that incontinence could be an issue. The bad news is I do have ED. The good news is I have never experienced incontinence.
The worst news was the call I got from Cleveland Clinic several weeks after the prostatectomy. A doctor in urology told me that the pathologist had found prostate cancer in my right seminal vesicle. My PSA after the prostatectomy was 2.0, and it should have been non-existent. A PSMA scan later confirmed that there was an uptake of prostate cancer on the backside of my pouch.
My gastroenterologist at CC had stated from the beginning he thought I might need to lose my pouch. However, my medical oncologist back home told me he didn’t think removing my pouch should be considered a “cancer surgery.” That got me to thinking about my future. I was so unhappy with my j-pouch. I had had seven years of misery and constantly wondered "at what point do you throw in the towel? How do you make that decision when it would mean more surgery?" The decision to excise was actually a relief. I was ready to lose the j-pouch, I just didn’t know how to say when.
It turns out that my decision to excise the pouch was a good one. Dr. Hull, who had performed my j-pouch surgeries and now the excision, said that the cancer had grown from the backside of my j-pouch into the abdominal sidewall. I lost a liter of blood resulting from the removal of the pouch and the need to scrape the cancer tissue from the sidewall. This is why you need to be in a good hospital with a great surgeon.
My post-excision PSA number was .3. It has remained around that level for a year now without any medications or further treatment. I get a PSA test every 3-4 months locally here in Virginia, and follow up with a visit to my oncologist in Charlottesville (UVA). By the way, my oncologist was at Cleveland Clinic for eight years prior to UVA Hospital and knows all my docs there.
You asked about the biopsy. It was the transperineal procedure (between the scrotom and anus) and really not a big deal. It was weird for me though because I had okayed observation by residents and other doctors. I had a group of docs and others gathering around me with my ass hanging out and my legs spread apart in stirrups. I couldn’t wait to be put under!