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

All the best. Hope your quality of life improves substantially. Mine did.

Thankyou.
I've had it done & quite used to it, now.
Very happy with it.

I had RARP in 2015. Urinary incontinence was up and down for a few yers, but then around 2022, it persisted at 1-2 pads per day. My urologist had put the urethral sling surgery on the table from the get go, but said, only when and if I thought I was ready for it. Finally had the surgery in 2023. The change to complete continence was immediate and has stayed that way for over two years. No complications whatsoever. The stress incontinence was annoying, but not devastating. But now in retrospect, my QoL has been so much better for the past two years. I would do it all over again. And btw, my urologist had performed 100s, if not 1000s, of the sling operations. He knew what he was doing.

Fair warning, you will be sitting on bags of ice for a while with lots of swelling and black and blue. Not really painful, other than to look at.

Now this is all going to be tested again as a start EBRT for a local recurrence this coming Wednesday. I expect that my perfect urinary continence will be challenged, but we’ll see.

I am 79 and had my prostate removed 14 months ago. PSA still undetectable. Incontinence has been a problem from the start although I've seen some progress. At one time I was using 4-5 pads a day and now down to 2 with one being a night when I have very little leakage. Went through 40 sessions of pelvic muscle training which did help some but continue to experience stress incontinence. Recently had a urodynamics test which seems to indicate a recommendation toward AUS, which was a surprise since the urologist thought I was a candidate for a sling. Meeting with the urologist next week to discuss the test results and my options. For a few weeks I've been logging my leakage with the results defined in tablespoons. Some days if I've been sitting or laying for a good part of the day I will measure 3-4 tablespoons but if I am up more and been to the gym I will measure 10 tablespoons. The surgery was a huge success and I had no complications or side affects and am glad I chose surgery. The incontinence is a very different matter and I am just so tired of dealing with it, not just the leakage but the frequent trips to the bathroom. As my wife says I am consumed with it and it obviously affects our lives. Seems like the AUS has better results and many are glad they did it but compared to some my leakage is not nearly as much as others. Even thinking about waiting to see if my body heals further and it all goes away on its own. I guess that's my biggest decision....wait or do the recommended procedure based on the urodynamics test. Any comments are so very much appreciated.

@archtxt4u "tired of dealing with it"? I know exactly what that's like.
There is light at the end of the tunnel - and it's not a train.

The AUS would be a good solution. I had mine activated last July.
The sling is also an option - best for incontinence that's not too bad & being all internal, once it's healed, it just does it's thing, with no interaction required by you.

Your surgeon/urologist would know which of these is best in your situation.
But aside from occasional leaks, going from 7 pads a day to 1 is a life-changer.

Thank you very much.

@archtxt4u
You should probably consider a clamp in order to resolve the problem when doing things outside the house. I use it when I go to the gym, go somewhere for dinner, or going dancing with my wife.

I use a Wiesner clamp. You can keep it on for a couple of hours, but then they recommend moving it to another spot. It costs about $35 and comes with three different size options.

I'm with Jeff M.
An AUS for a two pad a day problem (which is very disruptive of your life) is a very large surgery. And usually demands a very good and experienced surgeon.
Using a clamp could give you some control of your life very quickly that you may find very adequate and still have the option of Sling or AUS if the clamp is inadequate.
At any rate, hope you can get on a path of relief quickly and successfully.

@jeffmarc
I had prostate surgery on September 3rd of last year. My PSA is undetectable, which I’m grateful for, but I continue to struggle with incontinence that has not improved at all despite more than five months of diligent pelvic floor exercises.

Biofeedback testing with my new physical therapist confirmed that I am performing the pelvic floor exercises correctly. However, I still need to build the habit of contracting the muscles proactively — for example, just before sneezing, standing up, or making other position changes. In addition, I need to do the exercises not mostly lying down as in the past, but while standing up and doing normal things like walking or anything else functional.

Currently, I use one pad at night and typically two to three pads during the day. About a month ago, I began using the Weisner clamp you mentioned during the day. To reduce the risk of UTI, I empty my bladder every hour or two and reposition the clamp periodically to minimize discomfort. If the discomfort becomes noticeable or persistent, I stop using it for an hour or two. So far, it has been helpful, but I’m unsure whether this is a sustainable long-term solution.

My surgeon referred me to a specialist who was ready to schedule an AUS implant right away. I told him, “Not so fast.” While I understand that the American Urological Association suggests considering further intervention if continence has not improved within six months — and I am now at about the six-month mark — I am not ready to move to another invasive procedure just yet. I would like to continue working intensively with my new PT for a couple more months and then reassess.

I would really appreciate hearing from others who have faced a similar situation. Did continued therapy beyond six months make a difference for you? How did you decide when it was time to move forward with AUS?

Thank you in advance for sharing your experiences.

@soli

RO’s at conferences say it can take up to a year for incontinence problems to be resolved. You’re right it may be too soon to jump on the AUS.

I tried Keagle‘s for Three or four months and found they didn’t help at all, But I’ve had this incontinence problem for seven years, I think it’s too late for that to really be functional