ProAct vs. AUS

I've shamelessly stolen this from another forum, but here's Sling vs AUS:

AdVance Bulbar Sling

Following the installation of the sling in May 2011, there was a terrific improvement and to all intents and purposes, I was dry. This state lasted for about six to nine months, but then there was a steady decline in performance to the point where I was again using fairly heavy pads (=TENA level 2).

By the end of 2013, the level of incontinence could be lived with but was beginning to weigh on my mind quite heavily. Following an unsuccessful attempt to get the local NHS interested, I went back privately to the hospital that performed my LRP and the implant of the sling, asking for an AUS. During the build-up to the procedure, a stricture was found and resolved by an Optical Urethrotomy, an unfortunate side-effect of which was setting my level of incontinence back to the three-months after LRP level.

The operation to insert the artificial sphincter was carried out on 21st October 2015. The model used is an AMS 800 from Boston Scientific. The procedure involved two cuts, one low down in the abdomen to take a small reservoir and one between the scrotum and anus to install a cuff and the operating pump. For details of the AMS 800, see:

DESCRIPTION OF AMS 800

I spent two nights in hospital, again with a catheter. I had relatively little pain, but a lot of bruising and swelling to the scrotum, much more than resulted from the LRP and sling implant operations. There was the usual abdominal post-operative problem of wind, and it has taken several more days than before for it to subside. Also post-operative constipation set in, but was resolved (somewhat painfully) about four days after the operation. The trip home was quite comfortable, particularly as the westbound carriageway of the M54 is now smooth tarmac instead of broken concrete.

I was on heavy antibiotics from three days before the operation to three days afterwards, and had to shower with an anti-bacterial wash for two days before the operation to minimise the risk of infection. Changing the waterproof plaster on the abdominal cut is easy, but the one underneath is quite difficult to get at, replacement requiring a compliant and skilled spouse and adopting a position that ladies in childbirth will understand.

Currently the AUS is locked off (fully open). I have a follow-up appointment on 4th November to check healing and that all the bits are still in the right place. Activation is planned for 2nd December.

The AMS 800 comes with a warranty (just like a washing machine) and a set of instructions for operating, activating and locking off the device. Also included is a dummy operating pump to practice with. One restriction to be adhered to is that if, for any reason I need to be catheterised in the future, the cuff must be locked open to avoid damage to the AMS 800 or at the worst, puncturing my urethra, so I need to carry the instructions with me. Normally this is not a problem but I am wondering how to communicate the presence of the device if I am unconscious at the time.... maybe a visit to a tattoo parlour?

Some observations so far (four days on from activation).

There is a technique for operating the pump. It is very slippery, so one-handed operation is a bit hit and miss (mostly miss), so the other hand has to be used to grasp the pipes above the pump to stabilise it, then the lower section of the pump can be squeezed to release the cuff. I'll keep an eye on this to see if one-handed operation is feasible with experience; if not, then using a urinal in gents' toilets seems to be out unless there is one with particular privacy.