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Considering an Artificial Urinary Sphincter (AUS): Need advice
I had a prostatectomy in 2013, followed by radiation in 2013 and more radiation in 2024. My leaking has continued to worsen. My new urologist recommended that I consider an artificial urinary sphincter. He says he’s performed “a lot” of them. By chance, he was a resident 3 years ago, assisting one of my previous urologists. He completed a fellowship last year and is now back at the University of Alabama at Birmingham. He’s taken over my care from my previous urologist who retired last year.
My questions: I know would want a surgeon who has done a lot of them successfully. How should I investigate? If my doctor says he has done a lot, should I believe him? What is a lot? If he says he’s had a good success rate, should I believe him? What is a good success rate? I doubt he’s going to give me his client list. All I know to do is to ask around, see if anyone has had AUS, find out who they went to, and ask what their experience was. I can do that here in this forum, but does that mean I’d need to travel to another city? Thanks.
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@peterj116
It so happens that I just finished a tele-visit with a USC Keck Medicine specialist in this area. One of the written questions I asked him was:
“I am also in the very early stages of considering an artificial urinary sphincter (AUS) for my persistent post-prostatectomy stress incontinence. If I ultimately decide to pursue both an AUS and sacral neuromodulation, is there a preferred sequence for these procedures? Would you recommend addressing one before the other, and if so, why?”
He said that the sequence doesn’t really matter and that we can tackle whichever problem is causing me the most trouble right now.
I told him that I am managing my incontinence with clamps during the day and pads at night, but I haven’t been able to get a handle on my OAB, which causes me considerable anxiety when I travel or attend social engagements. So, I’m leaning toward tackling the OAB first.
The nice thing about InterStim is that if it doesn’t significantly improve my OAB during the two-week trial period, the system can simply be removed.
Bottom line: I’m seriously considering going this route. Since the doctor is already booked for several weeks, I may be able to have the trial conducted before the end of the year.
I’ll keep everyone posted.
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1 ReactionAnother possible solution is this:
https://www.mayoclinic.org/medical-professionals/urology/news/expanding-neuromodulation-for-overactive-bladder-tibial-sacral-and-beyond/mac-20594008
Kinda like a pacemaker for your bladder.
They implant a small device in your lower back & somehow it send signals to the bladder to calm down.
I only read about it briefly, so don't know that much about it, but that option is certainly there.
@lagnafinc
How was the other said? It takes five to six weeks Before you have recovered enough to activate it. At that point, you are completely healed from the surgery. Activating it is no big deal once it’s activated you just use it. You get Used to using it in a few days.
@jeffmarc I am meeting with VA to decide on having the surgery sept 15
Sex is very important because none with leakage
@soli I had oab and got the axonics device it helped me a lot decreasing trip to bathroom. I did the pt, all the pills they did not work for me axonics was not a bad surgery at all. I also had an advance xp sling 5 months ago for minor leaking but did not stop my leaking. But at least I know I have done what I can to stop leaking. Because it is such a minor leak Doctor said he did not believe aus was worth the risk/ benefit at this time. Last week just got the ams700 implant. This will also be a life changer I hope. The axonics was an easy surgery with good results and little pain. It did help reduce leaking but not stop it. Most importantly I was not running to pee every hour. Best to you in finding relief.
I would seek another opinion. My pelvic floor Physical therapist at my first initial appointment suggested to get second opinions which was very interesting. Also, a lot is an intangible number.
@peterj116
Exactly. The InterStim I am leaning toward trying is the “sort of bladder pacemaker” implant you mentioned in your response above. The nice thing about it, as the specialist reaffirmed to me yesterday, is that if it doesn’t significantly improve my OAB during the two-week trial period, the system can simply be removed.
So, I feel there is really nothing to lose by giving it a try.
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1 ReactionHi Geno,
My question is purely academic at this point, but I do wonder: As part of your post-radical prostatectomy therapy, did your urologist prescribe Pelvic Floor Physical Therapy ("PFPT")? It is usually eight, weekly sessions where you are taught MANY exercises that go well beyond standard Kegel's, but those are incorporated as well.
I had to discover that PFPT "exists" by reading about it here on this blog. Knowing time was of the essence, I immediately called my physician and TOLD him that I want PFPT, and asked why he did not automatically order it for me in my post-op recovery? He "danced a bit" in his reply, trying to convey that "most men don't need it," and that they regain full continence within 3-6 months, which of course was "B.S." So...
I am curious if you had PFPT, and if so whether you saw any improvement? You of course had the additional factor of having radiation the same year as your surgery. You don't offer what your pre-surgical Gleason Score was, not what your final pathology report revealed (EPE, Surgical Margins, Cribriform Glands, Seminal Vesicle invasion, lymph node invasion, bladder neck invasion, etc.), and what your tumor classification was, like pT3b or 2T, etc. I am curious.
Having had radiation so soon, tells me one of two things...maybe both occurred: 1) Your pre-op Gleason was high, perhaps a minimum of 4+4=8, or even 4+5=9 or a 5+4=9; and...2) Your pathology report included EPE, surgical margins, etc., showing advanced staging and disease.
Good luck to you. The journey is long...it never ends.
@jasonfarmer
I’m a little puzzled by your comment.
The ams700 implant Is designed for getting an erection, not helping with incontinence.
Are you really saying that it not only gives you an erection on demand but also reduced your incontinence to almost nothing?
The AMS800 is the AUS used for incontinence?.
@rlpostrp There’s such a thing as Pelvic Floor Physical Therapy that is something more than Kegels? I’d like to find a provider in Birmingham, Alabama, that offers this. Thanks.