Treatment of prostate cancer with nerve-sparing radical prostatectomy

About the department

The Department of Adult and Pediatric Urology, Andrology at the Marien Hospital Marl offers the full range of diagnostic and therapeutic services for patients with diseases of the urinary system and for men with pathologies of the reproductive system. The team at the medical facility also admits children and adolescents with urologic diseases. The department has 62 beds for inpatient treatment. Therapeutic options include both conservative and surgical techniques. Many operations are performed using the innovative da Vinci surgical system. The department also successfully uses modern laser systems, including the GreenLight laser, a holmium laser, a thulium laser and the laser for water vapor thermal therapy. The key focus of the department's work is on cancer surgery for malignant diseases of the prostate, bladder, kidneys, and testicles. The department also specializes in the treatment of urinary incontinence and pediatric urologic pathologies. Prostate diseases are treated in a specialized center certified in accordance with the DIN EN ISO 9001 requirements. The department is headed by Dr. med. Hans-Jörg Sommerfeld.

Prostate diseases are the most common in the department. The specialists of the medical facility regularly admit patients with prostate cancer, benign prostatic hyperplasia (prostate adenoma), acute and chronic prostatitis, etc. To provide patients with the most comprehensive and effective treatment of prostate diseases, the department has a specialized center, which was the first in the Recklinghausen district and the second in Germany to be certified in accordance with the international DIN EN ISO 9001 quality standard. The treatment regimen for patients with prostate cancer is developed individually, based on the stage of the oncological process, a patient's general health condition, and their age. The main treatment for localized prostate cancer is a prostatectomy. The department's surgeons most often perform this intervention using the innovative da Vinci Xi surgical system. The risk of complications during such operations is negligible. In addition, doctors manage to maintain potency and normal urination, which ensures a high quality of life for a patient. Depending on the particular clinical case, surgical treatment can be supplemented with chemotherapy, radiation therapy (external and internal), hormone therapy, and other types of treatment.

A fairly common disease in men is benign prostatic hyperplasia. An accurate diagnosis requires a clinical examination with a digital rectal exam, ultrasound (transrectal ultrasound as well as kidney and bladder ultrasound scans), and the PSA test. Should the diagnosis be confirmed, doctors will begin to develop a treatment regimen. At the first stage of prostate adenoma, it is enough to take medications. At the second and third stages, more radical measures may be required. such as transurethral resection of the prostate or retropubic/transvesical enucleation of the adenoma. The department's specialists quite often perform laser treatment of prostate adenoma using the GreenLight laser, the laser for water vapor thermal therapy, holmium, and thulium lasers.

The department effectively treats kidney and bladder diseases in men and women. The most common pathologies in clinical practice include pyelonephritis, kidney cancer, kidney stone disease, bladder cancer, cystitis, and urinary incontinence. The first-line treatment for kidney and bladder cancers is the surgical removal of the malignant tumor. Whenever possible, the department's urologists prefer the da Vinci surgical system, which provides an excellent therapeutic result while practically not injuring healthy tissues. Robot-assisted operations allow a patient to undergo effective treatment in the shortest possible time. Cystitis and pyelonephritis are usually treated with drugs. In the case of kidney stone disease, drug treatment is also possible (at the early stages), but if large stones are detected, extracorporeal shock wave therapy, ureteroscopy, and, in the most complex clinical cases, open surgery (up to 1% of patients with kidney stone disease) are performed.

An integral part of the work of the department's specialists is medical care for men with andrologic diseases, such as erectile dysfunction, infertility, epididymitis, orchitis, urogenital tuberculosis, and other pathologies. Erectile function can be restored with drugs, intracavernous injections, and vacuum therapy. Should infertility be suspected, a comprehensive examination will be carried out to detect its causes. Effective drug therapy can often be provided, but, in some cases, the only way to conceive a child is to undergo surgery. For example, doctors perform operations to treat varicocele, microsurgical aspiration of sperm from the epididymis, and other manipulations that allow a man to become a father.

The department also admits children and adolescents with urologic diseases. The specialists in this area provide medical care for children with enuresis, bladder outlet obstruction, hypospadias, undescended testicles (cryptorchidism), hydrocele, and phimosis. The treatment can be carried out with both conservative and surgical techniques. In most cases, operations for urologic diseases in children are performed on an outpatient basis, without a mandatory hospital stay. In addition, sparing minimally invasive techniques are usually used.

The department's main clinical activities are as follows:

• Diagnostics and treatment of prostate cancer (all surgical interventions are performed exclusively using the da Vinci surgical system)
  • Open retropubic prostatectomy (radical prostatectomy with potency preservation)
  • Laparoscopic removal of the pelvic lymph nodes
  • Laparoscopic radical prostatectomy
  • Low-dose rate brachytherapy (internal radiation therapy)
• Diagnostics and treatment of benign prostatic hyperplasia
  • Transurethral electroresection and open transurethral resection of the prostate
  • Surgical enucleation of the adenoma in the case of a severe prostate gland enlargement 
  • Transurethral microwave thermotherapy (as an alternative when the use of anesthesia is highly risky)
  • Prostate adenoma treatment with the use of the GreenLight laser, the laser for water vapor thermal therapy, holmium, and thulium lasers
• Diagnostics and treatment of bladder cancer
  • Endoscopic transurethral tumor resection
  • Radical tumor removal (cystectomy)
  • Various forms of urinary diversion (for example, an artificial bladder, Mainz-Pouch I, Mainz-Pouch II, etc.)
  • Polychemotherapy (cisplatin/gemcitabine, MVAC, paclitaxel/gemcitabine)
• Diagnostics and treatment of kidney cancer
  • Radical and organ-preserving cancer surgery (nephrectomy/kidney resection)
  • Immunomodulatory therapy (interferon/interleukins/vinblastine)
  • Surgical treatment of kidney cancer using the da Vinci surgical system
• Diagnostics and treatment of testicular cancer
  • Surgical removal of the affected testicle
  • Lymph node removal in the area of ​​lymph drainage from the affected organ (retroperitoneal lymphadenectomy/modified lymphadenectomy with the preservation of nerve endings)
  • Chemotherapy (PEB, PEI, carboplatin) adapted to the stage of cancer; as monotherapy or in combination with other treatment methods
• Diagnostics and treatment of kidney stone disease
  • Endoscopic therapy through percutaneous and ureterorenoscopic approach
  • Stone fragmentation using flexible and semi-rigid lithotripsy
  • Extracorporeal shock wave lithotripsy
  • Chemical stone dissolution
• Diagnostics and treatment of urinary incontinence in men and women
  • Drug therapy
  • Exercises to strengthen the pelvic floor muscles and the use of electrical stimulation methods
  • Surgical procedures in accordance with the very latest scientific advances
  • Placement of special vaginal tapes
  • Surgical tightening of the pelvic floor muscles in the case of bladder prolapse (vaginosacropexy)
  • Bladder neck elevation (Burch procedure)
  • Artificial sphincter implantation for urinary incontinence in men and women
• Diagnostics and treatment of andrologic diseases
  • Treatment of erectile dysfunction (impotence)
  • Treatment of hormonal disorders in childhood and adulthood
  • Treatment of "male menopause"
  • Treatment of male infertility
• Diagnostics and treatment of urologic diseases in children
  • Conservative treatment of enuresis, including urinary incontinence due to neuro-urological causes
  • Treatment of bladder outlet obstruction: endoscopic and open procedures to eliminate improper urine outflow, surgical debridement for ureteropelvic stenosis
  • Hypospadias repair
  • Undescended testicle repair (cryptorchism)
  • Surgical sanitation for hydrocele
  • Circumcision for a tight foreskin: plastic, sparing and radical interventions
• Diagnostics and treatment of other urologic diseases in adults and children