Dr Jo Schoeman
Urological Surgeon

        

Service List 1

Prostate Surgery

Trans Rectal Ultrasound Guided Prostate Biopsies / Saturation TRUS biopsies

This is diagnostic procedure used to make a diagnosis for an elevated PSA. 12 biopsies are taken of the prostate. The 3 possibilities of an elevated PSA is: Benign Prostate Hyperplasia, Prostatitis or Prostate Cancer. Saturation biopsies include 24 biopsies and are generally recommended second time round. With the use of preoperative 3T MRI scanning, accurate minimal targeted biopsies can be taken.

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Radical retropubic prostatectomy with or without pelvic lymphadenectomy

This is the surgical management option for a prostate cancer which fits all the criteria set out by the Urology Society of Australia for Surgery. It is the complete removal of the prostate, seminal vesicles and bladder neck. It may include a pelvic lymphadenectomy. Most centers now offer this Robotically.

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Radical Perineal Prostatectomy

This is an alternative to a Radical Retropubic Prostatectomy for low-intermediate risk prostate cancer. Prostates are generally smaller than 50cc. Only a handful of surgeons in Australia offer this.

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Saline / Gyrus Trans Urethral Prostate Resection

The endoscopic resection of benign prostate enlargement. Usually done for large prostates, larger than 150cc, or prostates where PSA is elevated and biopsies have been negative, in order not to miss a Prostate cancer diagnosis.

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Low Dose Radiation Brachytherapy

This is a form of radiation for prostate cancer where 30-50 radio-active Iodine seeds are placed inside the prostate, radiating the prostate over the following 9 months. Only done for low risk, low volume disease and in prostates smaller than 50cc. Could have prolonged dysuria as side effect.

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Laser Trans Urethral Prostate Vaporisation Greenlight Laser

Endoscopic ablation/ vaporization of a benign enlarged prostate, using laser. This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage or clotting. It also allows a shorter hospital stay with minimal risk. A preoepartive PSA should be normal prior to surgery, otherwise needs work-up for prostate cancer where indicated.

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Trans urethral Bladder Neck Resection

For those guys with normal sized prostates but a prominent bladder neck causing all the irritating symptoms of an enlarged prostate.

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Trans Urethral de-roofing of Prostate Abcess

Non invasive opening of an abscess found in the prostate, Very similar to a TURP with the exception that the bladder neck is preserved thus maintaining prograde ejaculation to some extent.

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Retro pubic / Suprapubic open Prostatectomy

For those large benign prostates where a TURP would be too time consuming, and too dangerous. Generally prostates over 200cc. More risks are involved such as hemorrhaging with blood transfusions. Generally not done in Australia commonly. Could be seen as first line therapy by some prominent American Urologists. Commonly done in first world Africa for large prostates. Higher morbidity rates.

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Robotic-assisted Radical Prostatectomy with or without pelvic lymphadenectomy

This is the surgical management option for a prostate cancer.

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