Atificial Sphincter After Prostatechomy

 

 I would appreciate some comments on the timing of having an artificial sphincter implemented.  I had a robotic radical prostatectomy 4.5 months ago.  Regardless of doing 90 to 135 Kegals a day, I have not made progress in control of my urine.  During a 15 hr. day I lose on the average 20oz. (568 grams) onto pads.  I seem to stay dry at night while in bed but lose a couple oz. in getting up and to the bathroom.  My surgeon has not been alarmed at my degree of leakage and wants to wait until at least 9 months before considering an artificial sphincter.  I have gone to a different urology doctor of good reputation and who specializes in curing incontinence.  He wants to do a cystoscopy at 6 months and if everything looks good, and I'm still leaking as much as now, schedule the implant of the artificial sphincter.  His opinion is that if the leakage shows no improvement at 6 months, it will not look any better at 9 or 12 months.  Will appreciate opinions.

 

Reminderman

 

 

Dear knotreel,

Thank you for your reply about AUS.  It is very helpful to me since your leakage is very similar to mine in that the only time I can urinate is after sitting or being in bed at night.  I have been seeing a therapy nurse for evaluating whether or not I'm doing my Keglas correctly.  However, next week I'm going to a PT who specializes in urinary incontinence.  We'll see what happens.  I saw that you mentioned a leg bag.  What system did you use?  I have been using either pads alone or a penil clamp called the "squezzer" which works quite well but I don't use it unless I'm going out for more than 2 hrs.  Thanks again for your comments.

Regards,

Reminderman

Rem,

My situation has been similar to Ron's in many ways. He and I have written extensively about our journeys on the forum. In my profile below I have included links to threads I started. This includes my first attempt at a sling and then the AUS.

I also was a constant leaker after RP during the day. When sitting or in bed I could make it to the John in time. Otherwise, I would pretty leak completely dry if I was out and about. This never changed and I went to the one year mark before trying the sling which did not work at all for me and then I did the final fix of the AUS. Doing the tests Ron mentioned will give you a good view of your potential for a sling or the AUS. I would give it close to a year before you give in to either a sling or AUS. One never knows how honest these doctors are or whether they just want to do some surgery and make some $$.

I settled into pads and a clamp. The clamp was uncomfortable as hell but it kept me from needing to change pads two or three times a day. You will find a way that works best for you.

Feel free to email me from the address in the profile if you want to talk further and I will send you my phone number.

I'll chime in too. I am outnumbered here and don't want to get into a p*ssing contest. (Sorry, I couldn't resist.)
I plotted my progress daily and noticed that my curve began to flatten out at 150-200 ml / day. I went with the AMS AdVance Sling. It works normally but just takes a looong time to pee. 2 minutes 30 seconds.
Keep it in mind if your leak gets below 200 ml/day and have residual control.
Jeff

I feel your pain brother, I am 7 months post davinci and still incontinence.  Usually  2-3 pads a day @ 150ml per day, it seems to be getting better, some days are better than others but the curve is yet to flatten out.  Uro does not seem too concerned, says I am still healing.  Probably will do cysti\scope with my 9 month check and psa.  Some guys have good luck...continence at cather removal, others are like us playing the wainting game and the stress of making more decisions on what to do, most guys have to wait for the 1 year mark.  Patrick Walsh's book says 98% should be pad free by 1 year.  I was having urge incontinence going 7-8 time a day, uro perscribed ditropan, seemed to help with the severe urge to go every hour.  There is another drug called imipramine that others have taken, suppose to relax the bladder muscle and tightens the muscle tone of the external sphincter.  BTW I just about gave up on the kegals, I still do them but I felt I was overdoing the exercise.  Good luck, there are a lot of us in the same boat.

Rem, I don't use an external catheter "system"  but just parts. So, I will offer you the "parts" that worked best for me and a little discussion.
1. The condom catheter, I like best the Hollister Extended Wear, This is a heavier built unit that is not prone to kinking. There are LOTS of choices for the cath but in think that their intended market leans to the bed ridden or wheel chair bound and some or most catheters are not well suited for active people who don't have some some major health issues rather than people like us who just have incontinence. Almost all decent catheters come in sizes, so you have the right diameter. So get a couple of sizes to try.
2.Leg Bag, The actual bag construction is not that important but the straps are. Since you are walking around doing stuff, and not an invalid, you will need fairly tight straps and only fabric straps will be of any use to you. I used to prefer the Hollister 19 oz bag which comes with some fairly nice fabric straps and I recomend that one to you to start with since this will be an experiment. But after a while you might find the straps are a little too narrow and dig into you leg and sometimes a straps will come undone while you are walking around. So, I switched to a strap the has buttons on it, UroCare Fitz-All, and a UroCare vinly leg bag with twist drain and that is the bag that I ended up with.
3. Extension tube. Get the 18" latex tube (non sterile is fine) and trim to proper lenght.
That's all you need. any probaly all you should buy for the first try.
Other stuff, things that became part of "system" were Torbot Skin-Tac-H which I needed to keep the catheter stuck on without leaking. They tend to loose their grip on me as the day wears on and this product works good for that and you can still get the catheter off without too much trouble(pain). Along the same vein, Some adheasive remover like Uni-Solve wipes or 8oz bottle is nice to have. You will probably want to somehow anchor the extension tube down to your thigh. Tape can work but I ended up using a tab style catheter holder, Cath-Secure mulit purpose tube holder.
Now, here is some other things you might wonder about. the catheter. change daily. The tube and bag lasts about a month but must be washed out daily and sanitized to prevent infection. I used a squirt bottle of Chlorox Cleanup and water and left this in the bag overnite. The cath holder will last about a week. I recomend shaving all the hair off your penis and maybe some clip short or shave around it too. shave a spot on you thigh where you will put the holder.
All this stuff, I found at Allegro Medical supply online. If you go to this site expect to be overwhelmed a bit with the choices available. If need be I can put togheter a list of their item numbers. You night find as I did the items they give you at hospitals and drs. offices to take home are really the low end on quality and stuff is avaialble that really is pretty good.
So, I hope this helps.
Ron

Hi Reminderman,

You are way too early to think of slings or AUS.
At 4.5 months you still have a reasonable chance for continence.
Wait at least a year; My prostatectomy was Oct 09, My Aus goes in Aug 11 (22 months).
If by PT, you mean electronic biofeedback or electronic stimulation, It did not work for me, but it has helped some people.
It may work for you.
I am trying external catheters now but so far, no joy.
My uro suggests a clamp for very active days only.
He insists that no clamp be used for a year; this is to give your sphinkter a chance to improve on its own.

Hope this helps,
Bob