Dudley Seth Danoff's Blog, page 6

Sex, Romance, and Relationships: AARP Survey of Midlife and Older Adults

AARP recently published a survey on sex, romance, and relationships in midlife and older adults (age 45 and older). One of the key findings was the answer to the question, what does a happy sexual relationship look like? Those who are the most satisfied tend to have the following:

A sexual partner (but not necessarily a spouse)
Frequent sexual intercourse (more than once a week, but not necessarily daily)
Good health (self and partner)
Low levels of stress
Absence of financial worries

Marriage does not necessarily increase sexual frequency or satisfaction. In fact, 48 percent of those who are single and dating say they have intercourse at least once a week, compared to 36 percent of those who are married, and 60 percent of dating singles are satisfied with their sex lives, compared to only 52 percent of those who are married.

The study also noted a dramatic change in sexual attitudes in the older set. The percentage of those who agree that people should not have a sexual relationship if they are not married has dropped precipitously, from 41 percent ten years ago to 34 percent five years ago to 22 percent today.

Surprisingly, about 20 percent of the people surveyed in this age group engage in self-stimulation at least once a week. The presence or absence of a sexual partner is not a factor, as virtually the same percentage of those with sexual partners say they engage in self-stimulation at least once a week as well.

Not surprising, the men and women surveyed have different sex attitudes, regardless of age. For instance, sex is far more important to the overall quality of life and more critical to a good relationship for men than it is for women. In addition, nearly twice as many men as women admit to having had a sexual relationship outside their long-term relationship.

Ethnicity also makes a difference. Hispanics in this older age group are more sexually active and satisfied than the general population. And regardless of gender or ethnicity, those with a regular sexual partner have a more positive outlook on life, both present and future, than those without a regular partner do.

Good health is always a critical factor that affects sexuality and performance, particularly in this older population. High blood pressure and high cholesterol are the most common adverse medical conditions reported by this group, followed by arthritis or rheumatism, back problems, diabetes, and depression.

Fantasies are not just for the young. About 25 percent of the AARP population surveyed has sexual thoughts, fantasies, or erotic dreams at least once a day. The most common fantasies include the following:

Having sex with a stranger (38 percent)
Having sex with more than one person at a time (21 percent)
Having sex with a celebrity (19 percent)
Having sex in public (11 percent)
Having sex with someone of the same sex (9 percent)

In addition, men are significantly more likely to report fantasies of having sex with a stranger or having sex with more than one person at a time than women are.

And what about romance? To keep romance in their relationship, the most common practice (cited by nearly two in three men and women of all ages) is telling each other, "I love you." Second, and very close, is recognizing special occasions, like birthdays and anniversaries. On the other end of the spectrum, less than 20 percent of men responded, "Romance? What's that?"

Better health and less stress top the list of changes that would improve current sexual satisfaction for both men and women in this age group. However, men are nearly twice as likely as women to say that better personal health would improve sexual satisfaction. Men are also more likely to cite a better financial situation as a helpful improvement, along with a partner who initiates sex more often, a more adventurous partner, and a younger partner. Women, on the other hand, are nearly twice as likely as men to say that no change is needed.

In the end, sex, romance, and relationship attitudes in the AARP age group (45 and older) are not much different from the attitudes of the younger, healthier, stronger, and more sexually active youthful group. Things may slow down a bit with age, but in the end, relationships can be just as rewarding and meaningful and emotional, proving once again that "romance has no boundaries."

 

Penis Tattoo? Don’t Even Think About It

I recently came across an article in the Journal of Sexual Medicine from Kermanshah, Iran, that reported a case of priapism (an erection lasting longer than four hours) following a penile tattooing.

A 21-year-old male presented to the hospital with a partially rigid penis of three months’ duration. At the time of his examination, the penis was half rigid with a tattoo on its dorsal (back) surface and a smaller tattoo on the tip. The patient stated that the tattoo was created just prior to the priapism and noted bleeding from the deep penile tissues for several days after the tattooing.

You may, of course, be curious as to what was tattooed. The tattoo on the dorsal surface of the penis reads in Persian borow be salaamat, which apparently means “good luck with your journeys.” The patient also had the English letter M tattooed on the tip of his penis, and he admitted that M was the first letter of his girlfriend’s first name.

The patient had no known causes that are normally associated with priapism, such as penile injury, sickle cell anemia, perineal injury (injury to the area between the anus and the genital organs), tumors, or drug injections.

One theory suggests that the priapism was secondary to the deep penetration of the needle by the tattoo artist. In Iran, tattoos are created manually using a handheld needle. This traditional Iranian technique allows no control of the depth of the needle penetration. After tattoo artists pierce the skin with the needle, coloring material (henna, ash, or other natural pigments) is then applied on the perforated skin surface.

The multiple piercings necessary to complete the tattoo apparently created a fistula (an abnormal passage) between the deep artery and the veins of the penis. As a result, more blood was entering the penile channel than could naturally be evacuated. The fistula formation caused a pooling of the blood outside of the vessel wall. This pooling and the stoppage of flow resulted in fibrosis of the penis tissue and created a permanent semierect penis. Under usual circumstances, the fibrotic damage caused by priapism results in the subsequent inability to get or maintain an erection adequate for penetration. But because this patient is 21 years old and the apparent damage was incomplete, he is able to get a partial erection and is capable of having intercourse. This case is the exception rather than the rule.

The takeaway message? Having someone repeatedly stick a needle into your penis for the purposes of tattooing is a bad idea that can result in grave consequences.

Penis Tattoo? Don't Even Think About It

I recently came across an article in the Journal of Sexual Medicine from Kermanshah, Iran, that reported a case of priapism (an erection lasting longer than four hours) following a penile tattooing.

A 21-year-old male presented to the hospital with a partially rigid penis of three months' duration. At the time of his examination, the penis was half rigid with a tattoo on its dorsal (back) surface and a smaller tattoo on the tip. The patient stated that the tattoo was created just prior to the priapism and noted bleeding from the deep penile tissues for several days after the tattooing.

You may, of course, be curious as to what was tattooed. The tattoo on the dorsal surface of the penis reads in Persian borow be salaamat, which apparently means "good luck with your journeys." The patient also had the English letter M tattooed on the tip of his penis, and he admitted that M was the first letter of his girlfriend's first name.

The patient had no known causes that are normally associated with priapism, such as penile injury, sickle cell anemia, perineal injury (injury to the area between the anus and the genital organs), tumors, or drug injections.

One theory suggests that the priapism was secondary to the deep penetration of the needle by the tattoo artist. In Iran, tattoos are created manually using a handheld needle. This traditional Iranian technique allows no control of the depth of the needle penetration. After tattoo artists pierce the skin with the needle, coloring material (henna, ash, or other natural pigments) is then applied on the perforated skin surface.

The multiple piercings necessary to complete the tattoo apparently created a fistula (an abnormal passage) between the deep artery and the veins of the penis. As a result, more blood was entering the penile channel than could naturally be evacuated. The fistula formation caused a pooling of the blood outside of the vessel wall. This pooling and the stoppage of flow resulted in fibrosis of the penis tissue and created a permanent semierect penis. Under usual circumstances, the fibrotic damage caused by priapism results in the subsequent inability to get or maintain an erection adequate for penetration. But because this patient is 21 years old and the apparent damage was incomplete, he is able to get a partial erection and is capable of having intercourse. This case is the exception rather than the rule.

The takeaway message? Having someone repeatedly stick a needle into your penis for the purposes of tattooing is a bad idea that can result in grave consequences.

When Pain Really Counts: Testicular Torsion

I recently taped a segment of The Doctors, a television show syndicated nationwide on CBS that discusses various issues of medical interest moderated by a panel of real medical doctors. The subject of the segment was testicular pain.

The discussion was prompted by an e-mail from Mike in Orlando, Florida, who expressed a common concern every man has experienced. He wrote: "Dear Doctors: Every guy knows it's really painful to get hit in the groin, but is there a time when you really have to worry?"

I explained to the audience that "Even to think about it hurts. A baseball takes an unexpected bounce, an opponent misses a kick on the soccer field and his foot has only one place to go, you are speeding along on your bike and you hit a bump—all result in really one painful thing: a shot to the testicle, one of the most tender areas on a man's body." This has happened to all of us.

The good news is, because the testicles are loosely attached to the body in the scrotum and are essentially made of a spongy material, they are able to absorb most collisions without permanent damage. You will definitely feel pain if your testicles are struck or kicked. You might also feel nauseated for a short time. If the testicular injury is minor, the pain should gradually subside in less than an hour, and any other symptoms should go away as well.

However, if the pain is rather sudden in onset and the scrotum is swollen or bruised, and if you have nausea and vomiting that lasts for more than an hour, this is a true urologic emergency. You must immediately see a doctor because you could have testicular torsion, which occurs when the testicle rotates around the spermatic cord. The testicle is attached to the end of this cord and hangs in the scrotum. The spermatic cord contains an artery to the testicle, a vein from the testicle, and a vas deferens, which carries sperm from the testicle to the prostate area. When this cord suddenly twists, the arterial blood supply to the testicle is immediately strangled, and the testicle can literally die from the lack of circulation. This twist or rotation causes sudden and severe pain and swelling. It often occurs spontaneously, sometimes when a man is sleeping, or it can come following straining or trauma.

Most cases of testicular torsion occur in younger men ages 12–25. To see torsion in a male younger than 12 or older than 25 would be unusual. Torsion of the testicle is a medical emergency. Unless it is corrected, the testicle will be lost. If the torsion is discovered and corrected within the first 6–8 hours after occurring, the testicle will be saved more than 90 percent of the time. After 12 hours, the chances of salvaging the testicle fall dramatically. After 24 hours, the testicle cannot be saved, no matter what is done. This will result in the loss of the testicle's function and may affect fertility.

If the torsion is discovered in a timely manner, the surgery is quite simple and straightforward. A small slit is made in the scrotum by the surgeon and a suture is used to attach the testicle to the scrotal wall in such a manner that the testicle is unable to twist. The surgery is usually done on both sides as a preventive measure.

The takeaway message is this: "Not all testicular pain is equal." If the testicular pain is rather sudden in onset and lasts more than one hour, a diagnosis of testicular torsion is likely. Testicular torsion is a true emergency and must be fixed in a timely manner.

Do Homeopathic Remedies Have A Legitimate Place In Promoting Male Health?

An editorial published by the Lancet, the respected British medical journal, entitled "The End of Homeopathy" demands that doctors recognize the absence of real curative powers in homeopathic medicine. The analysis concludes that, although homeopathic medicines have been around for more than 250 years and have attained cult-like status among their aficionados, the only effect they have is on the mind.

Swiss researchers compared the results of more than 100 trials of homeopathic medicines with the same number of trials of conventional medicines in the treatment of a wide variety of illnesses. The homeopathic agents had no more than a placebo effect.

The article further points out that the debate has continued for years, even though homeopathy, when subjected to the precise scrutiny of well-controlled studies, fares badly when compared with conventional medicines, noting that "the more dilute the evidence for homeopathy becomes, the greater seems its popularity."

As the debate continues, Bayer HealthCare has been accused by the Center for Science in the Public Interest (CSPI) of falsely claiming that selenium in its One A Day vitamins may reduce men's risk of prostate cancer.

Last year, the National Institutes of Health completed a seven-year, $118-million study and concluded that "selenium does not prevent prostate cancer in healthy men." Furthermore, a study involving more than 35,000 US and Canadian men called the Selenium and Vitamin E Cancer Prevention Trial (SELECT) was halted in October 2008 because researchers concluded that selenium did not protect men from prostate cancer and perhaps increased the incidence of diabetes in some of the subjects. Several other studies determined that selenium almost tripled the risk of developing diabetes.  This finding led to a dramatic warning from the American College of Physicians that "long-term selenium supplementation should not be viewed as harmless and possibly a healthy way to prevent illness."

In an editorial in the Journal of the American Medical Association, Peter Gann of the University of Illinois at Chicago urged that "physicians should not recommend selenium or vitamin E—or any other antioxidant supplements—to their patients for preventing prostate cancer." In spite of these developments, Bayer HealthCare touts selenium for preventing specific prostate "issues" and reducing prostate cancer risk!

Nine prominent cancer researchers wrote to the Federal Trade Commission in support of CSPI's complaint about Bayer's advertising. The SELECT trial "was the largest individually randomized cancer prevention trial ever conducted, and, given its high rates of adherence and its statistical power, it is unlikely to have missed detecting a benefit of even a very modest size," wrote the researchers. "Bayer HealthCare is doing a disservice to men by misleading them about a protective role for selenium in prostate cancer."

At this point, it would appear that Bayer HealthCare adheres to the credo of P. T. Barnum that "there's a sucker born every minute"!

 

The Link Between Birth Control Pills and Prostate Cancer

A worldwide study involving more than 80 countries found a significant link between oral contraceptive use and increased prostate cancer cases and deaths. The reason, supported by several studies, suggests that estrogen exposure increases the risk of prostate cancer and, more specifically, that the high concentration of estrogen in birth control pills is released in urine and ends up contaminating the local water supply. The transmission of estrogen through the water supply is believed to have a link to increased rates of prostate cancer in men.

Data from both the International Agency for Research on Cancer and the United Nations World Contraceptive Use 2007 was analyzed. The surprising results were consistent in all countries studied and were not affected by a country's wealth. No correlation was found between other forms of contraception (intrauterine devices, condoms, and vaginal barriers) and an increase in the incidence of prostate cancer. Prostate cancer has been associated with sexual transmission, but in this wide-ranging study, sexual activity had no impact.

To date, established risk factors for prostate cancer are age, ethnicity, and family history. The exposure to oral contraceptives and increased estrogen levels in the environment can now be added to the list.

 

You Are What You Eat: Low-Fat Diet Impacts On The Growth of Human Prostate Cancer Cells

A recent report published in Cancer Prevention Research, a peer-reviewed journal of the American Association for Cancer Research, stated that men who ate a low-fat diet with fish oil supplements for four to six weeks before having their prostate surgically removed had a slower cancer-cell growth in the prostate tissue than men who ate a traditional, high-fat Western diet.

In addition, the study showed that blood obtained from the patients after the low-fat, fish oil diet slowed the growth of prostate cancer cells in a test tube, while blood from men on the Western diet did not. It seems that heightened levels of omega-3 fatty acid from fish oil and decreased levels of omega-6 fatty acid from corn oil directly affected the biology of the cells and slowed prostate cancer growth.

Dr. William Aronson, the study's first author, said that "the finding that the low-fat, fish oil diet reduced the number of rapidly dividing cells in the prostate cancer tissue is important because the rate at which the cells are dividing can be predictive of future cancer progression. The lower the rate of proliferation, the lesser the chances that the cancer will spread outside the prostate, where it is much harder to treat." Dr. Aronson went on to say that "based on our animal studies, we were hopeful that we would see the same effects in humans." This study suggests that following a low-fat, fish oil diet would have a favorable effect on the biology of prostate cancer cells.

It has long been a truism that you are what you eat. And anecdotal evidence tells us that a low-fat, high-protein diet has been beneficial in the treatment of prostate cancer. A large number of my patients follow this diet with favorable outcomes.

Furthermore, the incidence of prostate cancer among African American males is relatively high compared with Caucasians. However, the incidence of prostate cancer in Africans is very low. Theoretically, African Americans and Africans share a common genetic pool; their main difference appears to be one of diet. The African American diet, in general, is very high in fat content, while the contrary is true of the African diet. Diet studies are often difficult to evaluate because the subjects fail to comply with a strict dietary regimen. However, this observation between African Americans and Africans seems to hold up.

In a typical Western diet, about 40 percent of the calories come from fat. In the Aronson study, the group following the low-fat diet was consuming 15 percent of the calories from fat. In addition, this group took five grams of fish oil per day to provide omega-3 fatty acids. Incidentally, omega-3 fatty acids have been found to reduce the incidence of heart disease and to fight inflammation, which has also been associated with certain other cancers.

Further studies are currently being conducted with one group of men following a low-fat, fish oil diet and the other group following a traditional Western diet, and the progression of their prostate cancers is being tracked. Both study groups were taken from a subset of men who have been diagnosed with prostate cancer but have chosen active surveillance (getting regular checkups and biopsies but not receiving treatment for the disease). The results of this ongoing study will be of great interest.

 

Delaying Ejaculation: A Urologist Tells You How

It is impossible to come up with a universal definition of premature ejaculation because so much variation exists among individuals. I have met women who are perfectly satisfied with intercourse that lasts two or three minutes, while others are frustrated when their partners cannot last more than fifteen or twenty. Do you and your partner feel that you reach orgasm too quickly? If so, there are many practical steps you can take to solve the problem.

The key to prolonging intercourse is to become so well tuned to your own body mechanisms that you can take action to hold off ejaculation before it is too late. Ejaculation is basically a two-step process. As arousal increases, you eventually reach the point of no return: ejaculatory inevitability. This stage is the moment when you feel that you are going to climax and that there is nothing you can do to prevent ejaculation.

Physiologically speaking, you are correct; there is nothing you can do to prevent it. Once that point is reached, the ejaculation reflex is set in motion, the muscles of the perineum (the area between the anus and the genital organs) forcefully contract, and the seminal fluid is already on its way out. In seconds, the expulsion stage is triggered. To delay ejaculation, you must be aware enough to do something before the point of inevitability sneaks up on you.

The first step is to pay close attention to physical sensations as you approach ejaculation. Just as you learned when to start braking your car as you approach a stop sign, you can learn to recognize when you are getting too close to the point of inevitability, which is the time to make adjustments. Some men try to distract themselves by thinking of anything besides what is going on: baseball, work, or something nonsexual. Even though this technique does slow down the process, it also separates you from the intimate connection of making love and ultimately detracts from your full enjoyment of the moment.

A more effective and far more enjoyable technique is to alter the way you are thrusting when you approach the point of inevitability. Changing the angle, speed, or depth of your thrusts will shift the sensations away from the head of your penis (which is the most sensitive part), thereby delaying ejaculation. Intercourse does not have to be limited to deep, rapid thrusts. You can make love slowly. You can move in a circular motion or enter only partway. The variations are limitless. The secret is to pay attention to the sensitivities of your own body and then make the appropriate adjustments to your sexual technique.

You can also stop thrusting entirely. Try suspending motion for a while and just lying together with your penis fully penetrated. This practice is a great way to reduce arousal and prolong intercourse. It can also be wonderfully romantic. When you feel you can resume thrusting without ejaculating immediately, begin again slowly.

Another approach is to withdraw entirely. This "start and stop" method is often recommended by sex therapists. When you feel yourself nearing inevitability, simply pull out and rest. If your relationship is a good one, your partner should understand the need for this step and welcome the opportunity to engage in other erotic activities. This is the time for using your hands, lips, tongue, or any other body part that gives you pleasure while at the same time giving your penis a break from direct stimulation. When you resume intercourse, it will be that much more intense, and your total time of penetration will increase. Do not be afraid of losing your erection if you stop thrusting or pull out entirely. You might lose it, but so what? It will come back with the right stimulation.

Another effective technique is the "withdraw and squeeze" technique. You or your partner should forcefully squeeze the head of the penis between your thumb and forefinger for a few seconds. This maneuver abruptly diminishes the level of excitation so that you can resume intercourse at a lower threshold and prolong ejaculatory inevitability.

The same can be said for the Valsalva maneuver: hold your breath and bear down as if you were having a bowel movement (without, of course, doing so). This action will increase your intra-abdominal pressure and delay ejaculation.

It is important not to view early ejaculation as a personal failure. Occasional premature ejaculation is probably due to a long lapse between orgasms or to nervousness: a new, passionate love affair might be so exciting that the threshold for orgasm is lowered considerably. Even if the problem is chronic, I can assure you that it is not a sign of permanent inadequacy or diminished manhood but simply a matter of habits that can be changed with practice and patience. The good news is that, no matter where you start from, you can vastly increase your ejaculatory control.

 

Fighting Testicular Cancer With Self-Exams

Testicular cancer, which affects mainly younger men, is relatively rare. This form of cancer is the most easily treated of all tumors in the genitourinary system. Just a few decades ago, more than 90 percent of patients with certain types of testicular cancer did not survive five years. Today a majority of cases are curable.

Consider the incredible story of champion athlete Lance Armstrong. After being diagnosed with testicular cancer that spread to his brain, Lance underwent successful testicular and brain surgery, extensive chemotherapy, and radiation therapy. Lance went on to set multiple world records by winning the Tour de France, a race that is arguably one of the most rigorous and demanding of any sporting event in the world, seven times!

Lance's victories are a testament not only to his own incredible willpower but also to the result of a successful cancer treatment. Without the amazing advancements of modern medicine, none of his accomplishments would have been possible.

In most cases where surgery is required for testicular cancer, one of the two testes is removed. Cancer rarely affects both at the same time. The surviving testis will compensate by producing additional testosterone. Even if both testes have to be removed, normal masculine functioning can be preserved with testosterone injections, patches, or topical gels. These treatments maintain normal levels of testosterone.

Unlike prostate cancer, testicular cancer occurs mainly in men under forty. Regardless of your age, however, I strongly suggest that you examine your testicles monthly and feel for suspicious lumps (and educate your male children as well). Just as women (from teenage years on) need to examine their breasts for lumps to screen for breast cancer, men need to examine their testicles. The more often you examine yourself, the more familiar you will become with the structure of your testicles and the more equipped you will be to detect any abnormalities. The best time for self-examination is after a warm bath or shower when the scrotum is relaxed. Your testicles should feel like hard-boiled eggs without the shells: smooth and void of lumps.

Report anything suspicious to your physician for further evaluation.

 

Robotic Surgery— A Better Mousetrap For The Treatment of Prostate Cancer

Not all patients diagnosed with prostate cancer are candidates for surgical removal of the prostate gland. Those who are will benefit greatly from the da Vinci robot-assisted prostatectomy, now widely performed at most major hospitals throughout the United States.

Having practiced urologic surgery for more than 40 years and having treated more than 10,000 patients with prostate cancer, I have seen prostatectomy techniques evolve from a rather crude, open operation, to a more refined, nerve-sparing, open procedure, to a laparoscopic radical prostatectomy, to the elegant, precise, da Vinci laparoscopic robot-assisted prostatectomy practiced today.

In all my years of practice, I have seen no single entity evolve so dramatically in terms of technical advancement, patient comfort, nerve preservation, and continence protection as with this surgical technique. New alone does not mean progress, but new and better does!

The use of the robot-assisted da Vinci surgical system has quadrupled in just the last four years and is currently used in some 2,000 hospitals around the world. The reason? It is a better mousetrap.

The da Vinci robot is not actually performing the prostatic surgery; its arm merely mirrors the movements of the surgeon's hands on two joy sticks, as the surgeon sits at a console and controls the robot.

No large incision is necessary when using the da Vinci system. The operation is performed laparoscopically with instruments that are inserted through ports (small keyhole slits) in the abdominal wall. The da Vinci "wrists" allow the "surgical hand" to rotate 360 degrees and angulate at almost an infinite number of angles. In addition, the surgeon sitting at the da Vinci console sees the field via a 3-D camera, which brings both clarity and magnification to the surgical field. Any experienced surgeon who has participated in the evolution of the traditional open operation to the da Vinci robot-assisted operation will attest to the dramatic improvement.

Unlike the rigid tools in traditional laparoscopic surgery, the wrists at the tip of the da Vinci arm allow the surgeon to pivot and twist the wrist in such a manner not possible by any other technique. And, unlike many surgeons who become fatigued, the robot filters out any apparent hand tremors.

But some feel that the da Vinci talents may not be up to those of physicians. Dr. Marty Makary, a surgeon at the Johns Hopkins School of Medicine in Baltimore, has stated, "For the patient, there's clearly no difference." I strongly disagree. Although, as Dr. Makary says, "There's never been a study showing clinical superiority," I can assure the reader that, from my clinical experience over thousands of cases, there is!

Dr. Makary has made the case that the robot is more of a marketing tool to attract patients than a medical one to improve their care. Although it might be true that the term robot is marketable, its superiority in both surgical technique and patient outcome is undeniable.

The critics of da Vinci prostatectomy, including Dr. Makary, say that the sensory feedback upon which surgeons rely is gone and that the da Vinci cannot tell whether the body parts are firm, squishy, bony, soft, delicate, or hard. Given that scenario, it might be easier for a surgeon to accidentally cut the wrong body part.

But an experienced robotic surgeon does, in fact, get a tactile feel, by a combination of the movement of the robotic wrist and the 3-D visualization of the wrist in action, associated with an enhanced depth perception. The argument that there is loss of tactile or sensory feedback always seems to come from those who are not experienced with the da Vinci.

More than 4,000 published studies on the da Vinci show that, when compared with open surgery, da Vinci surgery resulted in fewer complications, less blood loss, and faster recovery.

There is some debate in urologic circles about whether there is a significant difference between traditional laparoscopic prostatectomy and da Vinci robot-assisted laparoscopic prostatectomy. The greatest advantages of the da Vinci technique are the magnification, the flexibility of the operating wrist, and the 3-D visualization of the operating field. It is certainly true that, in terms of pain, scarring, and length of hospitalization, the laparoscopic approach and the da Vinci robotic technique are about equal.

The Institute for Clinical and Economic Review examined da Vinci surgery as part of a 2009 report on prostate cancer treatment. Dan Ollendorf, the institute's chief review officer, states, "There was no evidence of major benefit from the robot compared with open surgery." This conclusion does not match my experience. Mr. Ollendorf further states, "What matters most is the experience of the surgeon, not the chosen tools." I certainly agree that the experience of the surgeon carries significant weight, but given surgeons of equal experience, the da Vinci will win every time.

Performing surgery with the da Vinci system adds about $1,600 to the cost, an increase of about 6 percent, according to a 2010 analysis in the New England Journal of Medicine. The da Vinci system itself costs between $1.2 and $2.2 million. In most centers, it is used in a wide range of specialties, including gynecology, orthopedics, and cardiology. Of course, the more the robot is used, the lower the per-use cost becomes.

Viewing the entire landscape of surgical approaches to prostate cancer surgery, I have no doubt that the da Vinci technique, when used at a well-equipped medical center by an experienced surgical team, is, indeed, a better mousetrap.