SkyDaver's AdVance sling journey

Inspired in no small part by KW's postings, I thought I'd provide some direct experience with the AdVance Male sling.

My sig lines show the PCa part of the story, and I'd like to add that when my surgeon came out to tell my family the outcome of the DaVinci surgery, he told them (and has repeated) that he wished that he had recorded it to use when he teaches the DaVinci procedure. The nerves peeled off with out any problem, and he expected me to regain continence & potency quickly. I also started bio-feedback physical therapy to help work on effective Kegels and hopefully regain my continence.

While I did see some improvement, it was not as good as I wanted; I was wearing the belted pads through the end of November, and I don't think I switched to the male pads, or saw nighttime dryness, until sometime in January.

In late January 08, my surgeon referred me to Dr. George Webster, also at Duke Univ. Medical Center, about the incontinence. Prior to the visit, I was to keep a three day voiding log, and to bring in a days' worth of used pads for them to weigh.

Dr. Webster discussed the collagen injections, the InVance sling, an AUS, and the AdVance sling. He felt that based on my leakage amount, I would be a good candidate for the AdVance sling, but that he would want to do urodynamic tests & cystoscopic examination first.

At the time, I was simply unwilling to consider even the testing, let alone another surgery (I was not quite 4 months post surgery), so I didn't schedule anything.

In the meantime, I started keeping track of my daily pad weight. In my opinion, a pad count is just a very gross measure, since there are so many different reasons why a guy might change out a pad. One guy might change a pad every time there was some leakage; another might not change until the pad was full.

I bought a digital kitchen scale, and started keeping my pads in a ziploc bag. I work at home, so this was pretty easy for me. Every morning, I'd weigh the pads, recording the total weight of the pads & the ziploc bag, the pad count, and the net weight (gross - (dry weight per pad*pad count - weight of the bag). I put the net weight into a spread sheet, and started plotting. The line plot was pretty scattered, depending on my activity, so I started running the data through a smoothing algorithm (LOESS, if anyone cares) and plotting that line.

I felt like I was improving, and could certainly see by the plot that I was, but by June, it seemed like I'd plateaued at about 100ml/day (urine weighs so close to 1 gm for 1 ml that the difference is inconsequential). In July, I had enough, and at the end of July, got my urodynamics study and cystoscopy.

I'd been apprehensive about the tests, but they really were no problem. They squirt some numbing gel into your urethra, then put in a catheter and a very thin wire with a pressure transducer. They then start filling your bladder, and watching it on a fluoroscope (or something similar) and measuring the volume & pressure in your bladder. I think the whole procedure lasted 30 minutes or so, and while it's not something I'd take up as a hobby, it was much more tolerable than I'd expected.

The cystoscopy was even easier. It's just a fiber optic camera, very thing. The surgeon inserts it, goes in, takes a look at the external sphincter (I think that's the one we have left), takes a look at the bladder, has you squeeze down to see how hard you can close down the sphincter, and then you're done.

The amount of volume I could hold, the pressure levels, and the cystoscopy all showed that I was a good candidate for the AdVance sling. Tomorrow morning I go to the Duke outpatient surgical center at 0darkthirty, and have the procedure done.

I'll post about the procedure itself as soon as I'm up to it.

I hope your sling proceedure goes well for you. I knew going into mine that I was probably out of range for any real dryness but I thought if I could cut down on my leaking at all it would be worth it. I work in a industrial environment so saving and weighing pads would have been a bit more of a hastle for me. I commend you for the tracking and work you have done to measure your progress.
I wish you well,
KW

A brief rewind to arrival at the center.

Spoke with anesthisist (can't spell THAT without looking it up!) and once I found out that in addition to the spinal block, I'd be on a sedation cocktail, I chose that with no hesitation. I had problems with general before.

While in preop, they started that cocktail, and injected my back with the spinal block. No big deal.

I remember being in the operating room, seeing the surgeon, and the next thing I knew, I was in recovery.

It did take quite a while before the spinal block wore off (although I could move my toes, and feel my skin, my scrotum had no sensation at all, and it was a while before I could do a Kegel)

Finally at about 2pm, they put about 300ml into my bladder, and took out the catheter. For the first time since Oct 3, 2007, I didn't leak! I couldn't even pee. After waiting and trying a bit, I did (as directed, and under the watchful eye of the recovery nurse, per my request), I did the self-catheterization, got about 350 ml out, and have been discharged.

I'm lying in bed at the hotel, with very sore butt cheeks and a very sore left inner thigh. I swear someone was leaning on it! Other than that, I'm pain free. I think I'll take some Tylenol, and ibuprofen a little later. I have oxycodone, but I'll save that unless I need it.

The surgeon reported that the procedure went very well, and my urethra coapted (I think that's the term) right as he tightened up the sling.

I've got to keep a log of how much I void, how much I get out via catheter, if necessary, and tomorrow, we'll drive home from Durham to Winston Salem, NC

I'm in a good mood so far, but tired.

48 hours post surgery, still no voiding. I'm told that's not uncommon. I've had a number of urges, and it's seemed that I was going to go, but no luck. I've had to self-catheterize, which isn't terrible, but certainly not something I want to take up as a hobby.

Not much swelling, or apparent bruising, but I'm pretty sore when I move from sitting to standing or back. Soft recliner is fine (once I'm in it.)

From the video that the docs at Sentara did, it seems that recovery is pretty quick, and lots of guys overdo it too soon. I'm a pretty active guy, and I think one of the docs must have been pressing their elbow into my thigh to keep me slowed down until the incisions heal, and the sling arms scar into the muscle tissue

On the other hand ... total dryness so far

My husband is a few weeks ahead of you and wanted to let you know where we are.  my husband is 6 weeks post op from his operation for the Advance Male Sling.  We go tomorrow for his post operation examination.  He is completely dry ( from 10 -12 pads per day ) and only has slight wetness if he sneezes or coughs and only when he has a full bladder.   After surgery, the inner thighs were very painful, which we were told were a result of the position of the surgery.  Sitting on a small child's inner swim tube helped healing and comfort   Also - he stopped wearing a pad - which was not easy since he had worn one for several years.  He switched to a ladies light pad - because  we could not find one that was thin enough for what was needed.  But the change was important even if just for the mind.  Even though , my husband is an active guy,  he did not push himself after the operation.  He did not ride his bike, lift anything, or excercise - other than walking.  It was not easy - but according to the advice - what was needed to be done.  Try to keep inactive.  It was hard for my husband.  We wish you a continued successful journey - we will keep you posted.  and for others reading this message -  Urology Times April 2008 has a great article  - the title is "Male Continence :  Expert Insight"  and an April 2007 Article - "Expanding treatment options with the next generation of male Sling Technology".  Both articles are available on the web and are round table discussions of several doctors - including those from Duke.    

let us know how you are doing ???   Mrs D.

Skydaver = he was able to void on his own the day after the operation.  However, a delay was discussed so we were prepared for that.  THe doctor and his staff, as well as all the articles, kept on impressing that there should be the least amount of activity to aid healing.  No lifting or heavy excercise -  it is still a major operation - your body needs time to heal  - keep postivie

let us know how you are doing - mrs d

another day, and still no pads :-D

getting less pain with movement (not that it has been bad at all) so I need to watch out not to over do things for another 6 days or so.

Started to get some measurable volume when I void, although I still need to self catheterize. Spoke with the PA, who told me that isn't a problem; I'm just slow in getting the swelling to go down. He passed on a message from Dr Webster, who has spoken to some of his colleagues experienced with the AdVance sling, and no one reports a patient who was never able to void on their own. His longest (so far ... I don't really want to go for the record!) is 10 days.

Went for a half mile walk with the wife & dog; she took his leash, since he's a 30lb Welsh Terrier that's only 14 months old ... he's good on a leash, but sometimes can start to take off, and I don't want to make any sudden moves.

I think I can get used to this dry stuff ... Oh yeah, and I need to go update my sig file

Ed,

My doctor recommends very limited activity for 10 days, then more normal, but avoiding heavy lifting, for 6 weeks. I don't exercise other than walking or golfing, so I'll be pretty much normal next week. I haven't even driven since the surgery. I'll also double check with him about driving my car (manual transmission) before I do. Even if I get clearance, I'll make sure I'm not getting any pain or tugging before I drive.

I will also hold off full golf swings for at least four weeks, though.

not much progress today, but we re-read some of the articles, and it seems to be impossible for the sling to be too tight, and no one has reported long term retention ... must be patient ....

Day 9. Getting a bit discouraged.

Still very little voiding on my own. Trying to ignore some of the urges ends up giving me urge incontinence, instead of stress incontinence. Had to change twice today.

Surgeon re-assured me that no one has had long term retention problems, but it's still very disheartening to have to shove in the d*** catheter. The urge leaks today were also a huge frustration.

I'm a little overdue for an update;

Starting last Friday, I began to get some more output. It's still not up to where it needs to be, but it did improve, and the residual volume (ie., when I use the catheter) is usually getting down near or below 100ml.

I go to see the doctor tomorrow, where they'll do a cystoscopy, and a urodynamics test (just like pre-surgery)

Hopefully, I'm just kinda slow.

The doc has me recording two values, the amount I void on my own, and the amount that I get out with the catheter. The voiding volume is (slowly) increasing; usually 60-100 ml, and the catheter volume is decreasing; I'm getting down to 100 ml (and sometimes less) from the catheter. That's good (I think) since we've found some info saying that retention of more than 100 ml is considered dysfunctional

I use the catheter in the morning when I get up, and just before I go to sleep, and if we're going out somewhere that I don't have ready access to a bathroom.

I go back to work on Wednesday; it certainly has made it much easier on me to be a telecommuter!

KW,
Thanks for the kind words, but I don't know if the sling is working yet.
I've had an indwelling catheter in me 24/7 except for the brief voiding test, so I really don't know yet, if I'm dry.
Ed