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Any experiences with Artificial Urinary Sphincter (AUS) or Sling?

Posted by 160972 @160972, Jan 17, 2023

Hello. Just wondering if anyone has a long-ish term experience with either the sling or AUS. I had a partial nerve sparing prostatectomy in 2018. I have mostly recovered ED issues, but urinary incontinence persists (1-2 pads per 24 hours-fairly light). I now am looking at salvage radiation for BCR, and have read and been briefed that both issues will get worse down the road. I'm 62, very active-run, lift weights, etc. Could easily live with the current state, but concerned about getting worse. Thank you for any input

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Profile picture for peterj116
peterj116 | @peterj116 | Apr 26 7:44pm
In reply to @paulrn "I have had Holep surgery after which I had massive blood loss and since the surgery..." + (show)
Profile picture for paulrn @paulrn

I have had Holep surgery after which I had massive blood loss and since the surgery have permanent incontinence due to massive damage to the sphincter. I currently wear 6 pads per day as the incontinence is total. I have been advised I need an AUS cuff fitted through yet another operation but before then I want to investigate how successful this operation is, because I believe from most of the comments I have read this is not 100% guaranteed to stop the incontinence or even arrest it. I still have cancer left in the prostate which requires radiation after the AUS cuff is fitted. I have to say I am not happy with having his procedure or whether it will stop my incontinence as there appears to be more negative than positive responses to those who have had the AUS cuff surgery.

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I'm on waiting lists for an AUS.
I've read that it's 90% successful & we'd only need one light pad per day, just in case.
They last 7-10 years, but I haven't read too many bad things about them.
Looking forward to it.

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peterj116 | @peterj116 | Apr 26 7:47pm
In reply to @paulrn "I have had Holep surgery after which I had massive blood loss and since the surgery..." + (show)
Profile picture for paulrn @paulrn

I have had Holep surgery after which I had massive blood loss and since the surgery have permanent incontinence due to massive damage to the sphincter. I currently wear 6 pads per day as the incontinence is total. I have been advised I need an AUS cuff fitted through yet another operation but before then I want to investigate how successful this operation is, because I believe from most of the comments I have read this is not 100% guaranteed to stop the incontinence or even arrest it. I still have cancer left in the prostate which requires radiation after the AUS cuff is fitted. I have to say I am not happy with having his procedure or whether it will stop my incontinence as there appears to be more negative than positive responses to those who have had the AUS cuff surgery.

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BTW.... here's the difference
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grandpun | @grandpun | Apr 27 7:47am
In reply to @paulrn "I have had Holep surgery after which I had massive blood loss and since the surgery..." + (show)
Profile picture for paulrn @paulrn

I have had Holep surgery after which I had massive blood loss and since the surgery have permanent incontinence due to massive damage to the sphincter. I currently wear 6 pads per day as the incontinence is total. I have been advised I need an AUS cuff fitted through yet another operation but before then I want to investigate how successful this operation is, because I believe from most of the comments I have read this is not 100% guaranteed to stop the incontinence or even arrest it. I still have cancer left in the prostate which requires radiation after the AUS cuff is fitted. I have to say I am not happy with having his procedure or whether it will stop my incontinence as there appears to be more negative than positive responses to those who have had the AUS cuff surgery.

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Hi "paulrn",
I'm glad to be the poster child for successful AUS 800. Mine implanted March 2023 and it works very well. I do wear one very thin pad per day. Often it catches that 'last drip', sometimes nothing, occasional stress induced leak.
In 2 years only 2 unexplained and unexpected major leaks.
Life is normal with it and blessed that it solved my 6 to 8 pad per day incontinence.
Best of luck to you and pick a well experienced, talented surgeon.
(Hint: consider finding a 'gender affirming' surgeon. Though that specialty prompts lots of political and "values" distractions, IMneverHo, they know that surgical territory and techniques the best.)

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smc24 | @smc24 | Apr 27 2:03pm
In reply to @paulrn "I have had Holep surgery after which I had massive blood loss and since the surgery..." + (show)
Profile picture for paulrn @paulrn

I have had Holep surgery after which I had massive blood loss and since the surgery have permanent incontinence due to massive damage to the sphincter. I currently wear 6 pads per day as the incontinence is total. I have been advised I need an AUS cuff fitted through yet another operation but before then I want to investigate how successful this operation is, because I believe from most of the comments I have read this is not 100% guaranteed to stop the incontinence or even arrest it. I still have cancer left in the prostate which requires radiation after the AUS cuff is fitted. I have to say I am not happy with having his procedure or whether it will stop my incontinence as there appears to be more negative than positive responses to those who have had the AUS cuff surgery.

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My AUS, Boston Scientific's AMS 800 work very well after two or three years. Going from complete incontinence to 95% was a true life changer. For me, a wise and successful decision.

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cgerhardt | @cgerhardt | Sep 13 4:00pm

I had RP in 2008. Incontinent from the start. Did a Virtue sling, no help. Then AUS in 2010 and it worked fine for 15 years. Now considering need for a replacement AUS.

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asolidrock | @asolidrock | Sep 18 7:41pm

My sister sent a link on that device but I wasn't sure about. I think mine will get better over time. 🙏

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tomf | @tomf | Sep 19 7:07am

I've written on this same subject somewhere else in this website, but I will try to replicate my comments here. Two and a half years after my RALP I was down to one medium pad per day (stress incontinence) but was not satisfied with that. I called myself Jack the Dripper. So I got a referral to the guy in my Urology Group who does slings. He said I was a good candidate but would not see significant improvement because one medium pad a day is considered "continent". I went ahead anyway. The surgery was outpatient, and I took a good 6 weeks off from anything harder than walking. The improvement in continence was immediate. That was 7 months ago, and I am still happy with the outcome. I do wear a "what if" pad in my underwear when I am hiking in mountainous areas, playing pickleball or golf because little squirts do occur now and then. But if I have nothing overtly physical to do, I can go without a pad. It was the Boston Scientific sling and I am now 73.

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jeff Marchi | @jeffmarc | Sep 19 10:23am
In reply to @tomf "I've written on this same subject somewhere else in this website, but I will try to..." + (show)
Profile picture for tomf @tomf

I've written on this same subject somewhere else in this website, but I will try to replicate my comments here. Two and a half years after my RALP I was down to one medium pad per day (stress incontinence) but was not satisfied with that. I called myself Jack the Dripper. So I got a referral to the guy in my Urology Group who does slings. He said I was a good candidate but would not see significant improvement because one medium pad a day is considered "continent". I went ahead anyway. The surgery was outpatient, and I took a good 6 weeks off from anything harder than walking. The improvement in continence was immediate. That was 7 months ago, and I am still happy with the outcome. I do wear a "what if" pad in my underwear when I am hiking in mountainous areas, playing pickleball or golf because little squirts do occur now and then. But if I have nothing overtly physical to do, I can go without a pad. It was the Boston Scientific sling and I am now 73.

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The problem with the sling is that it doesn’t work well if you have had radiation. It is contraindicated to do it if you have had radiation.

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koji480 | @koji480 | Sep 20 7:27pm

I have had an AUS for three years. Very glad I decided to get it.

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jimgaudette | @jimgaudette | Sep 20 11:42pm

I had an AUS implanted 8 months ago. A total life changer! I had a Boston Scientific AMS 800 implanted. My urologist said that a sling wasn’t an option because I have had radiation. The implant generally lasts 7 to 10 years, with some people getting 20. I went from 5 or 6 maximum pads per day to one very thin pad. The reason that I needed any pad at all was because of the radiation, she couldn’t make the implant too tight for fear of erosion to the urethra. If you choose the implant, make sure you choose an experienced surgeon with this procedure. I had an IPP implanted at the same time and am VERY happy with both. Although some people experience pain for several weeks, I had very minimal pain, swelling or bruising. My surgeon was very slow, careful and thorough. Medicare paid for the whole thing. Talk to your doctor about the criteria necessary for that coverage.

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