How much did you know about your Urologist before RALP?

@animate
I did not have RALP.

But your questions and wanting feedback from others on their experience is exactly why MCC is here.

There is plenty of research showing that mire experience correlates strongly with better outcomes. I had my RALP four months ago. I still have some stress leakage, ED, and climacturia. PSA is < 0.02 undetectable. My surgeon had close to 20,000 RALPs to his name. It is recommended that they have at least 2,000 and still do over 200 each year.

I think you're asking a good question. I was 70 when I had NS RARP last year at Mayo Phoenix. I think the number of procedures is a good question to ask to try to judge a surgeons experience. In my case, I researched the assigned surgeon and I found out he was a long time surgeon (something like 20 years) at Mayo, he had a long list of published articles, and he had great reviews. During the consult I asked if he'd be doing the surgery, or some resident. He told me he'd be teaching during the surgery, but he'd be operating the robot and doing the surgery. That was how I decided he must be pretty good if he's teaching at Mayo. I did ask him what he believed my odds, with him as surgeon, were for incontinence and ED. He told me at 1 year I had a 90% chance of being continent and 70% of not having ED. So even though I tried to assess his surgical expertise a different way, I do strongly believe the expertise of the surgeon matters. After surgery I was never incontinent (other than the normal accidents figuring out the new normal) and at 15 months my ED is gone and I'm fully back to normal. So although I didn't ask the number of procedures he's done (although I think that is a good question to ask), I did satisfy myself he was very qualified and experienced. However one determines it, I think getting an experienced and successful surgeon is worth the effort. Best wishes.

My urologist who detected the cancer was doing 35 per year. Unfortunately for him, he gave me John Walsh's "Surviving Prostate Cancer" book, which recommended finding the most experienced surgeon. I found one at the U. Wash Medical Center who was doing 115 per year, so I picked the latter.

No, but the general experience subject did come up when I asked him if they had the latest Robotic Surgery System. He said yes, it gives surgeons a haptic force feedback, but he had done so many of these he can't tell any difference between it and the older device. I looked it up and the force feedback in general helps newer surgeons physically get feedback on the pressure they are applying during surgery, if I understood it correctly?

I also asked if he was on commission, he indicated he was paid on salary.

Probably not very scientific on my part, but in various types of surgery I have had over the years I looked for the guy or gal that seems to be very experienced in the surgery I needed, but still stays current on the newest medical updates. A balancing act not always determined by how old they are, where they went to Medical School or patient reviews.

I had RALP 12 months ago at UC Irvine Medical Center. I was 67 Gleason3/4 psa 3 at surgery. My criteria for a surgeon was that they had performed at least a couple thousand of these procedures and they were at a hospital rated as a center of excellence (COE).
I found Dr Ahlering on Google Scholar as I read up on Prostate surgery and side effects. He had been a part of numerous studies about minimizing side effects of surgery. I believe he was head of Urology at the time and had performed several thousand procedures and was an instructor on RALP. I had spoken with another surgeon at a COE in San Diego who had actually performed more procedures and would have been a good choice as well, but I liked Dr Ahlering’s swagger!
When I asked him if it would be him or a Intern doing the procedure, he responded that the Interns would do prep and a couple other things, but that he would be doing “all the tricky parts”. When he asked me what my number one concern was, I said incontinence as I was a professional pilot. He responded “I am really good at that” … I said your hired!
After the medical workup and prior to surgery, he gave me a written estimate of how long I might have incontinence and ED. I think he said “95% continent within 30 days” and ED recovery to 95% of what I was prior to surgery.
After surgery, no incontinence whatsoever,…I threw away a box of pads. I still have some ED at 12 months, but it is steadily improving month by month and I think it will work itself out as predicted. I was told that nerves regenerate at 1/2 to 1mm per day so 12 to 24 months recovery should be expected.
The surgery was scheduled 6 months out so I had time to get in shape for it. I did cardio 5 or 6 times a week, cut down on Carbs. and lost enough weight to fit into the lower end of the body mass index chart. Also
did Kegals. All in all, things turned out OK so far and I get a call from him every 6 months to see how I am doing.

I wanted a RALP specialist that had done 2k+ operations and was currently doing 200+ a year, and could discuss with me their patient outcome statistics in terms of continence and ED. I wanted a surgeon that cared about their measuring their results and was always seeking to improve their technique. I had a good surgical outcome and I believe it was directly correlated to the surgeon’s skill.

Not all surgeons use exactly the same technique for RALP’s and some of the techniques that have a higher probability of continence and ED are more difficult to execute.

You can search for the surgeons that more frequently present at conferences the techniques they are using to improve outcomes.

I did not pick a place of excellence. I had originally went to see a urologist concerning an urgency to pee. I live in the Phoenix area and at the time Mayo did not take medicare. I picked a urologist with a private practice that specialized in prostate issues with a large elderly community in close proximity. After the biopsy we discussed that he did NS robotic surgery and was affiliated with the Banner Hospitals. I didnt ask any more questions. I did end up with ED and incontinence. I have since switched to Mayo and no apparent issues from the surgery. I would say that during surgery prep a late 50's assistant came to my room and said he would be assisting my Dr. He talked of his experience and was quite impressive. I never seen him again. I might suggest you find out who else will be in the room.

@beachflyer -- I had a similar experience after surgery. No incontinence at all (except a few minor accidents during the first 6 months as I figured out the new normal and fully resumed all physical activities). I did have ED, but it (very) slowly recovered until I fully recovered at about 15 months. I hadn't heard the 1/2 to 1 mm a day recovery, but that sounds like exactly what I experienced. Best wishes.

Thank you all for your kind and helpful responses. I do see that most of you did look into the surgeon's record to choose the most experienced and apparently this did result in favorable results. Good for you!

I wonder if anyone with relatively poor outcome results did not verify the surgeon's record and later found out that unfortunately he or she was still at the beginning of the learning curve?

I do understand that everyone's case is different and some might be subject to more possible complications or limited results, due to their particular circumstances, but I would assume that the surgeon's experience and skill should make a difference, to some extent. I am just interested in finding out from personal experiences to what extent this experience/skill can make a difference.

Thank you.