1. < Prostate Cancer

Sling, or artificial urinary sphincter?

Posted by peterj116 @peterj116, Dec 4 1:10pm

I'm getting way ahead of myself here, but terrible incontinence (9 pads per day) after 10 weeks is getting me down.

Given that I still can't move my pelvic floor muscles at all after 5 physio sessions (the physio was so frustrated, she's fled all the way to Canada. So now I have to start again) I'm thinking that surgery may be on the cards soon.

Has anyone had the sling or artificial sphincter done?
My GP was horrified at the prospect of the sling - saying that recovery is worse than the incontinence.

What is the recovery & success rate like for either procedure?

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peterj116 | @peterj116 | Dec 5 1:14pm
In reply to @survivor5280 "It's interesting this topic came up. I'm seeing a pelvic floor therapist preemptively now (pre-surgery) along..." + (show)
@survivor5280

It's interesting this topic came up. I'm seeing a pelvic floor therapist preemptively now (pre-surgery) along with a personal trainer to try to be as ahead of the curve as I can be and the therapist was talking about another patient with the AUS who raves about it and has even offered to talk to any of her patients about it. My first reaction was "well there's a sling that doesn't require activation" but it's hard to argue against the logic of regaining the second sphincter that was removed since it's something I've lived my whole life with. Given what I've read elsewhere and even in this thread, I think if I end up needing anything I'll opt for the device over the sling.

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That's odd coming from a physio. A sling or sphincter would be the backup plan if the physio's pelvic floor training didn't work. Sounds like they're planning to fail. Or I'm reading it wrong.

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lee61 | @lee61 | Dec 5 2:51pm
In reply to @peterj116 "Is the pad just for backup? I thought the balloon would squeeze the urethra tightly closed...." + (show)
@peterj116

Is the pad just for backup? I thought the balloon would squeeze the urethra tightly closed.
A bit scared of the pump in the scrotum. What if you squeeze the wrong bulge?.....

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My understanding is that the dr does not want the cuff around urethra to close off completely, Wears urethra out in that area. So I wear a pad during the day . Most days not to ..heavy with urine . Coffee, tea. Mnt dew will cause more leakage so I don’t over drink that stuff. The dr and his nurse explained and showed me how to hold the two tubes and squeeze the end of pump in scrotum to open cuff. This is the pump in scrotum and some of the instructions. Little bump on top of pump shuts it off. Dr said never shut it off. Let a urologist do that.

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2 replies
peterj116 | @peterj116 | Dec 5 8:56pm
In reply to @lee61 "My understanding is that the dr does not want the cuff around urethra to close off..." + (show)
@lee61

My understanding is that the dr does not want the cuff around urethra to close off completely, Wears urethra out in that area. So I wear a pad during the day . Most days not to ..heavy with urine . Coffee, tea. Mnt dew will cause more leakage so I don’t over drink that stuff. The dr and his nurse explained and showed me how to hold the two tubes and squeeze the end of pump in scrotum to open cuff. This is the pump in scrotum and some of the instructions. Little bump on top of pump shuts it off. Dr said never shut it off. Let a urologist do that.

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That makes sense. Good to know what it looks like. Thankyou.

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grandpun | @grandpun | Dec 6 8:48am
In reply to @peterj116 "Cool. Thankyou. I'll see if it's an option." + (show)
@peterj116

Cool. Thankyou. I'll see if it's an option.

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I had RALP 1/2022 and never had continence - 7 - 9 pads/day.
Early 5/2023 had AMS 800 installed by a super competent surgeon (found out he is a regional specialist in gender affirming surgery - he knows the territory!).
Yes, 6-weeks seems like a long time but you need the urethra under the AMS cuff to be completely healed.
Reason is, one of the (infrequent) failure modes of AMS is erosion of the urethra there.
But sooooo worth it!!! I just use a small pad just in case there's some leakage. If there is, it's usually very minor - drops only.
I've also been "lucky" because I had some blood in urine last March '24 and had a cystoscope check for any trouble. Blood had cleared up by time of cystoscope and no trouble found. Also, the lucky part, the urethra showed NO erosion. So I'm GOOD to go (literally).
If you choose an AMS I wish you at least as good an outcome as I have had.
Life can be good post PC treatments but you gotta work all the angles and get the best providers possible.
Good luck Brother!

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johari | @johari | Dec 6 10:04am

The decision between a sling or an AUS depends on your degree of incontinence. A sling is meant to improve degree of continence for men struggling with minor stress incontinence. An AUS is meant for men with higher degrees of incontinence (ie. multiple pads/day).
I had sling surgery about 6 weeks ago because 3 years post RP, I still struggled with minor stress incontinence, especially when I worked out in the gym or paddled (I co-captain a dragon boat team of prostate cancer survivors), so my urologist suggested I would be a good candidate for a Sling.
The surgery was straightforward and uncomplicated, catheter for 2 days, and given the location of the incisions (perineum and scrotum), it was a bit tender for about 2 weeks. Pain was easily managed with extra strength Tylenol for first week.
Once catheter is removed you will know whether it worked or not, and in my case, I am happy to report I am pad free at the moment. As I am just 6 weeks post sling surgery, I am only just gradually getting back to regular exercise, so the real test of how it performs under vigorous exercise (heavy lifting, high intensity cardio, paddling) remains to be seen. At this point, I can say it was successful.

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1 reply
tomf | @tomf | Dec 7 7:54am
In reply to @johari "The decision between a sling or an AUS depends on your degree of incontinence. A sling..." + (show)
@johari

The decision between a sling or an AUS depends on your degree of incontinence. A sling is meant to improve degree of continence for men struggling with minor stress incontinence. An AUS is meant for men with higher degrees of incontinence (ie. multiple pads/day).
I had sling surgery about 6 weeks ago because 3 years post RP, I still struggled with minor stress incontinence, especially when I worked out in the gym or paddled (I co-captain a dragon boat team of prostate cancer survivors), so my urologist suggested I would be a good candidate for a Sling.
The surgery was straightforward and uncomplicated, catheter for 2 days, and given the location of the incisions (perineum and scrotum), it was a bit tender for about 2 weeks. Pain was easily managed with extra strength Tylenol for first week.
Once catheter is removed you will know whether it worked or not, and in my case, I am happy to report I am pad free at the moment. As I am just 6 weeks post sling surgery, I am only just gradually getting back to regular exercise, so the real test of how it performs under vigorous exercise (heavy lifting, high intensity cardio, paddling) remains to be seen. At this point, I can say it was successful.

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I have my consultation in three weeks for a sling. I have exactly the right symptoms and am hopeful for a positive discussion with this new urologist (new to me, but very experienced at implanting slings). Wondering what questions I should have at the ready?

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1 reply
johari | @johari | Dec 8 9:21am
In reply to @tomf "I have my consultation in three weeks for a sling. I have exactly the right symptoms..." + (show)
@tomf

I have my consultation in three weeks for a sling. I have exactly the right symptoms and am hopeful for a positive discussion with this new urologist (new to me, but very experienced at implanting slings). Wondering what questions I should have at the ready?

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The only real questions or reassurances I needed were that it couldn’t make it worse, and the degree of potency I had gained back following my RP would not be compromised. I got those reassurances and so signed the consent to go ahead.
Recovery: some swelling and edema in the scrotum, tender for about a week when sitting. Get an inflatable donut pillow to sit on as it alleviates the pressure.

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tomf | @tomf | Dec 8 9:30am

Thanks. That makes sense and I will be sure to ask him. Unfortunately, I have no potency to compromise. After 22 months, nothing's happening. My surgeon assumes it will never return, but I keep up the VED therapy hoping he's wrong.

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peterj116 | @peterj116 | Dec 8 12:08pm

That's for that, guys. I'll be seeing the surgeon soon, but I get a feeling he won't want to install a sling or AUS for another year or so.

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1 reply
jeffmarc | @jeffmarc | Dec 8 12:35pm
In reply to @peterj116 "That's for that, guys. I'll be seeing the surgeon soon, but I get a feeling he..." + (show)
@peterj116

That's for that, guys. I'll be seeing the surgeon soon, but I get a feeling he won't want to install a sling or AUS for another year or so.

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Had a phone meeting Thursday with the urologist that specializes in incontinence. I am only using one pad a day and she said I should not do a sling or other techniques (Bulkamid, aus or ProAct) until I am using a lot more pads a day.

With the number of pads you were using you really need to have something done, She would’ve immediately have recommended I do something If I were Doing what you have to do. She essentially said that while we were talking.

It doesn’t make sense that you wait another year to do something when you are having such a serious problem

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