Case Study: Transfusion-Free Prostate Surgery
- Prostate removal always results in urinary incontinence (leakage) or impotence (erectile dysfunction).
- Blood products are always necessary for this operation.
Much to the amazement of his patients, John Stein, M.D., a urologist with the USC/Norris Cancer Hospital, regularly dispels these mistaken beliefs. “The primary goal of a radical prostatectomy is to remove the prostate tumor,” notes Dr. Stein, “while sparing the continence mechanism and, whenever possible, the neurovascular bundle (nerves and blood vessels) that surrounds it. In this way, we may help patients maintain both urinary continence and erectile function which would, in turn, improve the quality of the patient’s life.”
And, Dr. Stein adds, this “nerve-sparing” procedure can be done transfusion-free. “We have developed the surgical technique and expertise to perform this procedure without the use of blood products, and have been able to do it safely in patients who do not want transfusions.”
This approach requires extreme precision. “The prostate is situated deep within pelvis surrounded by a rich vascular structure,” Dr. Stein explains. “This area can bleed easily, therefore great surgical care must be taken to avoid the need for transfusion – the same meticulous care needed to maintain continence and erectile function.”
In addition, the anesthesiologist plays a key role by carefully lowering the patient’s blood pressure and thus decreasing the amount of bleeding from the cut blood vessels – a transfusion-free approach particularly effective in urology cancer patients.
Dr. Stein is also using synthetic medications such as Procrit to stimulate the bone marrow to produce red blood cells preoperatively.
“Without a doubt, the ability to perform transfusion-free prostate surgery is surgeon- and technique-dependent,” adds Dr. Stein. “I think patients are best served at institutions where they do a large number of nerve-sparing, transfusion-free radical prostatectomies.” A place like the USC/Norris Cancer Hospital.
John Stein, M.D.
While John Stein, M.D, assistant professor of urology at the Keck School of Medicine of USC, has earned a reputation for excellence in transfusion-free prostate surgery, most of his clinical and laboratory research focuses on bladder cancer and urinary reconstruction. In addition to publishing more than 75 peer-reviewed publications and 28 book chapters, Dr. Stein is on the editorial board for Urology and Techniques of Urology, and a reviewer for 12 different peer-reviewed journals.
Dr. Stein attended the University of Notre Dame for undergraduate work and earned his medical degree from the Loyola University Stritch School of Medicine. Before joining the USC faculty in 1997, he completed his internship and residency at USC, and a two-year fellowship in urologic oncology and reconstructive surgery at the USC/Norris Comprehensive Cancer Center and Hospital.
Jack Dyer and Loren Barrett Story
To John Stein, M.D., an assistant professor of urology who specializes in urological oncology surgery, the goal of a bloodless radical prostatectomy is no different than the goal of any prostatectomy: Remove the prostate cancer while sparing the neurovascular bundle that surrounds it. In this way, you can help the patient maintain urinary continence and erectile function. Click for more…
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