Urethral Sling for Minor Stress Incontinence

Posted by johari @johari, Feb 22 3:21pm

Hi all,
I have seen discussions around the Artificial Urinary Sphincter on this forum, but I am curious if anyone has experience with the "sling" to treat minor stress incontinence? I had a prostatectomy 3 years ago, and still suffer minor stress incontinence, but generally get by with one light pad / day. Some days are better than others, and I feel sometimes I could go without, but I am quite active, and so it is generally offering extra assurance as well as protection so I don't have to worry. I had sort of resigned myself to the fact that I would be a "one light pad / day guy" for the rest of my life, but when my urologist suggested referring me to another Dr to discuss surgery (AUS or Sling), it got me thinking. Research and discussions around the AUS I have come across seem to suggest this is done for guys with a higher degree of incontinence than I am currently dealing with, and at the end of the day, many still seem to be wearing a daily light pad. The idea of manually manipulating a valve in my scrotum everytime I need to release urine is not very appealing to me either. So I am thinking maybe the urethral sling is better, and could actually eliminate my need for any pad at all going forward (given the low degree of incontinence I am currently dealing with). And because I am so active in the gym, would a sling be affected by my level of activity (would it move out of position, for example, because of all the squats and other lower body exercises I do?).
Curious for any feedback! Cheers

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I had the “Sling” installed 2 years after my prostatectomy. I went from 2 large pads per day to one medium size pad. I do notice that coffee makes me leak more. But I need my coffee !

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Hi @johari, some members, including @firespooks and @kpgnsm have shared their experiences with the sling in this related discussion:
- Any experiences with Artificial Urinary Sphincter (AUS) or Sling?
https://connect.mayoclinic.org/discussion/longer-term-sling-or-aus/
Glad to hear that you're active and exercise regularly. Are you including Kegel exercises regularly too?

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Not to sound negative but for some us with the aus only other choice is a bag for life. We love having to play with our scrotum. Good luck.

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I'm going to discuss the sling with my proctologist as I'm a little over 1 year out and still leaking. Not badly but still.....

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@firespooks

I had the “Sling” installed 2 years after my prostatectomy. I went from 2 large pads per day to one medium size pad. I do notice that coffee makes me leak more. But I need my coffee !

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Hi @firespooks
Thanks for the info. My sense from all replies I get from anyone with an AUS or a Sling is that their incontinence is not actually "minor stress incontinence" when they go into the procedure, and so the outcome is that they still require a pad afterwards. Incontinence is never fully resolved.

My incontinence is definitely "minor stress incontinence" and I definitely get by with just one light shield per day. I am hoping to get to no pads at all.

Given what I am hearing, it sounds like complete resolution of minor stress incontinence is not the outcome with the sling or AUS.

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@johari

Hi @firespooks
Thanks for the info. My sense from all replies I get from anyone with an AUS or a Sling is that their incontinence is not actually "minor stress incontinence" when they go into the procedure, and so the outcome is that they still require a pad afterwards. Incontinence is never fully resolved.

My incontinence is definitely "minor stress incontinence" and I definitely get by with just one light shield per day. I am hoping to get to no pads at all.

Given what I am hearing, it sounds like complete resolution of minor stress incontinence is not the outcome with the sling or AUS.

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In my situation nearly 1 year out from prostate removal, a normal day was 4 - 6 max pads depending on activity level after pelvic floor training, physical therapy, etc. I researched both AUS and Sling and opted for AUS after my research and urologist consultations due to the severity of my incontinence. End result was no pads used after I retrained my bladder (overactivity after nearly a year of incontinence) following AUS activation, which took about 2 months. At times I do leak a few drops but it is minimal, which can be traced to not allowing enough time for closure of the AUS after urinating. That closure time varies between 1 - 2.5 minutes based on the number/strength of each pump. Urination after prostate removal is like when I was 18 years old again and takes about 15 seconds, thus you need to wait until the AUS closes before completing the process. Hope this helps others in making this decision. My overall goal of no pads was achieved, which was amazing given my starting point. I don't believe the sling would have provided these results - my urologist thought I might get to about 2 max pads with the sling.

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@johari

Hi @firespooks
Thanks for the info. My sense from all replies I get from anyone with an AUS or a Sling is that their incontinence is not actually "minor stress incontinence" when they go into the procedure, and so the outcome is that they still require a pad afterwards. Incontinence is never fully resolved.

My incontinence is definitely "minor stress incontinence" and I definitely get by with just one light shield per day. I am hoping to get to no pads at all.

Given what I am hearing, it sounds like complete resolution of minor stress incontinence is not the outcome with the sling or AUS.

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Any surgery, "minor" or otherwise, always carries risks of complications or side effects. As a former gynecologist who performed sling procedures (albeit on women) I can attest that things can and do go wrong. You must be sure the benefit you might gain is worth the chance you'll be left with a different problem to deal with.

I'm now 11 months post prostatectomy. For the past six months, I've been using one light (#1j pad daily and am very happy to live with that forever given the spectrum of what it's like for those of us with prostate cancer. The pad is mainly for the post void drips which I sometimes have.

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@trusam1

Any surgery, "minor" or otherwise, always carries risks of complications or side effects. As a former gynecologist who performed sling procedures (albeit on women) I can attest that things can and do go wrong. You must be sure the benefit you might gain is worth the chance you'll be left with a different problem to deal with.

I'm now 11 months post prostatectomy. For the past six months, I've been using one light (#1j pad daily and am very happy to live with that forever given the spectrum of what it's like for those of us with prostate cancer. The pad is mainly for the post void drips which I sometimes have.

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I am @ 9 months after surgery and my main leaking is also post void drip. I also 1 light pad a day. Seams I am not the only one like this . It is comforting to know I am not alone. Not to wish anyone this problem.

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I’m a week out of surgery. Catheter comes out in 3 days. What should I expect and prepare?

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@mgmathisusa

I’m a week out of surgery. Catheter comes out in 3 days. What should I expect and prepare?

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I had my surgery 13 months ago and I've been reading these posts for a year now. I can assure you, there is no one answer to what your future holds. Healing is going to take several weeks but your body will recover. Will you have ED? Yup, be prepared for needing medical help for getting erections. It might be pills, a VED device or injections (or some combination). But it will work if you give it a chance. Will you experience incontinence? Yup. But here is where the answers swing wildly. Some guys swear they are dry as soon as the catheter comes out. Some say it takes weeks; others months. I am finally "dry" after 13 months. Why the quotation marks? Because almost everyone who says they are dry, still puts a pad in their underwear for that occasional leak / potential embarrassment. I am like that. I still haven't conquered golf and pickleball days either. Stress leaking is worse during those activities. Why did it take 13 months for me? No one has had an answer. I did kegels faithfully but eventual exasperation got the best of me and and I went to pelvic floor therapy which is far superior to just doing kegels. The PT got me to my current condition and I assume I will be doing all these exercises at home daily for the rest of my life to be as dry as possible. I went through lots of days when I was sure I would have to get some artificial help with the incontinence (AUS or sling) but I am glad I didn't do that. I finally feel I have recovered to the point where I am at a place where I can take this for the rest of my days. Good luck and keep us posted about your recovery.

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