Dr. Jay Jhaveri operates on a patient while using a computer with a camera inserted inside the patient during a recent procedure at Henry Ford Hospital in Detroit.
 
Dr. Jay Jhaveri operates on a patient while using a computer with a camera inserted inside the patient during a recent procedure at Henry Ford Hospital in Detroit.
Photograph by: DAX MELMER , The Windsor Star

It was a moment of transcendent tenderness. Just a kiss between husband and wife, no more than a peck on the lips, but one that evoked their wedding day vows: in sickness and in health.

It came in the middle of a clinical and sterile demonstration in a crowded medical lecture hall at Detroit's Henry Ford Hospital.

The topic was male erectile dysfunction, a painful and possibly embarrassing subject that, despite the cost, has Canadian men crossing the border in increasing numbers for the latest advances in sexual healing.

Registered nurse Andrea Simone, a Windsor resident who works at the hospital's Vattikuti Urology Institute, conducted the demonstration. She showed the couple, we'll call them Paul and Paula, one way to literally inject sexual passion back into their love life.

Simone leaned between them, proffering a latex penis to demonstrate where the needle is inserted, "See? Just above the base, at the nine or three o'clock position."

Result? Erection.

As Simone moved on, the couple exchanged a kiss and sat back smiling, holding hands, grateful for a new lease on life and renewed hope in their marriage.

"I had cancer and needed radical surgery," Paul explained. "It was successful but the most important aspect now is the healing and recovery process."

"He's only 53 and a sex life is important to us," Paula added.

The Vattikuti Urology Institute, located in Henry Ford Hospital, is a 10-minute ride from downtown Windsor. Simone, who is certified to conduct postoperative consultation and suggest treatment, said Canadian men are crossing the border regularly, despite facing $35,000 in costs not covered by OHIP, because they desperately want options and hope.

Some face radical surgery to treat life-threatening diseases like prostate cancer, others have some form of erectile dysfunction that defies solutions offered by drugs like Cialis and Viagra.

A Windsor businessman, who agreed to talk about his experiences but didn't want his name disclosed, said he is seeking some reimbursement from OHIP after undergoing treatment at the Vattikuti institute for prostate cancer.

But even if he doesn't get any money back, it will have been worth it.

"My recovery has been nothing short of amazing. I've been told there's a 94 per cent chance I've got rid of the cancer. I like those odds."

And, he added "sexual potency" was already returning, with the aid of medication, weeks after his surgery, March 27.

"The old standard 'open procedure' would have cut out the prostate but I would be impotent the rest of my life," he said.

"This surgery saved the nerves.... I was put on low-dose Cialis and was back in two weeks. Unbelievable."

He decided to go to Detroit after researching options in Ontario and discovering he would have faced a fourmonth wait and might have to start treatment with chemotherapy. The Detroit doctors said they could operate in a month and guaranteed the latest in technology and technique. Postoperative care could give him his sex life back.

"Potency is a big part of being a man," he said. "To think about having to give that up in my 50s, now that's a tough pill to swallow."

In Ontario, there are a few robots available or coming on-stream, but use of the technology is limited compared with the U.S., where more than 80 per cent of the procedures are now done this way and more than 1,000 robots are in use. In Canada there are only a dozen.

Even with the cost, the patient said, the decision was easy. Here, he might still be on a waiting list or dealing with chemotherapy sickness. "How can you put a price tag on quality of life?" he asked.

Dr. Mani Menon, the doctor who pioneered the procedures at the Vattikuti Urology Institute, spoke in an interview about the advances in surgery and post-operative treatment the institute has developed. "We figured out a better way to preserve the nerves using the robot," said Menon, who is considered by colleagues one of the leading urologists in the world. In 2000, he became the first surgeon to remove a cancerous prostate using a robot.

"The robot gave us the ability to see nerve structures no one had seen in history," he said. "Once we looked with fresh eyes, we could see what was possible. There are nerves, like a spiderweb, at the base of the prostate. We called it the web of Aphrodite. The goal is to take out the prostate but leave the web intact."

The Da Vinci Surgical Robot resembles an alien insect, made of plastic and stainless steel, with six thin limbs wrapped in clear plastic sleeves. The apparatus almost swallows the patient, who reclines beneath its probing arms with feet raised and head near the floor.

During a recent surgery to remove a patient's cancerous prostate, surgeon Dr. James Peabody sat in front of a high-definition computer screen, manipulating the robot's instruments with video-game-like "joy sticks" and floor pedals. More doctors and nurses huddled over the patient, helping with sutures, suction and other tasks.

The robot's arms burrowed deep into the patient's abdomen through six "body ports," lifting, snipping and cauterizing. The procedure was magnified and projected onto screens in vivid detail around the operating table, allowing the team to do intricate work. Compared with standard surgery, there is relatively little blood.

"It also means you can do surgery with greater precision," Menon said. "With nerve preservation, 90 per cent of patients who had normal sexual function before are able to have erections again."

However, surgery is just the beginning of treatment.

"It takes 1½ hours for the operation," said Menon. "But the post operative care, with rehabilitation, can take hundreds of hours. The level of care here is absolutely unique. Nothing else approaches it."

While the operation unfolded, Simone was presenting a seminar in another part of the hospital. Dozens of men, many accompanied by their wives, attended.

"What happens after surgery is that the penis shrinks because the nerves are in shock," she said. "It can take a year before you have a natural erection again. The penis has to go through rehabilitation to stop permanent shrinkage.

"Sometimes, even if you can rise to the occasion, you can't sustain. After four months, it can atrophy. So start rehab, the sooner the better. You don't use it, you lose it."

It boils down to restricted blood flow to the penile nerves and flagging muscular strength, she said. As the body heals, normal function should return - in some cases within two to three weeks, in others one or two years.

Simone recommended starting with Cialis or Viagra, under the physician's direction. But there are other options. They include a vacuum erection device, worn over the penis that creates and maintains erections by pumping arterial blood into the unco-operative member and stretching it.

Another remedy is a product called Muse, a delivery system using a plastic applicator to insert a medicated pellet, half the size of a grain of rice, directly into the penis opening. The active chemical relaxes muscles and opens blood vessels to increase blood flow.

Simone said another method, the penile injection, "promises the best option for satisfactory intercourse." The "usually painless needle, when applied correctly" delivers an active ingredient to dilate blood vessels.

Simone, who wants to establish a similar service in Windsor, said the counselling sessions she offers and followup are all important in getting men through the post-operative blues and rebuilding confidence.

"What many don't know is prostate surgery has consequences," she said. "It causes leakage, incontinence and ED. They don't understand, (they) just want that cancer out.

"We give them the best shot at nerve sparing and recovering sexual function."

Read more: http://www.windsorstar.com/health/Aphrodite+with+video/6792707/story.html#ixzz1zaJs8Mi8