AdVance sling 31 May 2011

The following is what I had posted as a comment in another thread about the AdVance sling, then after reading a bunch of other threads, decided to post it as a new thread. It seems that most of the threads I found follow the original poster's experiences for awhile, then 'peter' out.


On 31 May 2011 I had the AdVance sling procedure. It's now 06 June 2011, my 6th post-op day, and things look encouraging. My retropube radical 'ectomy had been 13 July 2009. I was 58 at that time. I had only been able to achieve a certain amount of continence in the two years post rad'ectomy. I had fairly decent control through the night and in the early morning. I'd start having worsening control as the day would wear on. I had piss poor control when squatting, kneeling, sitting on the floor, exercising, riding the motorcycle. Most days I was able to get by with using only one Depend's guard in my briefs. Earlier this year things began worsening, and I'd sometimes have to put in a new guard during my work day.

My urologist hasn't done that many of the sling procedures. I believe I am his 4th or 5th, depending upon whether I was the 'to follow' surgery or the first surgery of the day. He performed the surgery on two of us. It was convenient for both of us and for the dealer rep who was present in the surgery. One of my questions prior to the surgery was the chance of it working 'too well,' and leaving me needing to cath myself afterward. He assured me that it was highly unlikely. That kind of outcome was with the prior sling procedures that screwed the ends of the sling into the pubic bones. In this surgery, the ends are left unsecured, and the body's tissues grow into the sling to secure it. All this current sling does is raise the bulb of the urethra superiorly for better alignment of the internal and external sphincters.

And that is why I'm supposed to be mostly lying down. No lifting more than five pounds for four to six weeks post surgery. I'm standing at this laptop with it on a box on the table so that I'm not sitting. Pretty soon I'll head back to the couch.

So far I've been able to pee without problem. I'm pushing fluids, and need to void about every hour or two, voiding between 125cc and 200cc. I get a strong sense of urgency, and have no problem making it to the bathroom where I'm using a urinal to keep track of the void amounts. I'm not having leakage despite my struggles to get up from the bed or couch. I can sit, but sitting gives me an insecure feeling regarding control, so I'm avoiding it mostly.

Because straining with lifting or moving has to be avoided, so that the sling doesn't loosen before the tissues grow in, I highly recommend using a stool softener a few days prior to this surgery and then continuing using one. I also am slugging down a gulp of mineral oil once per day and having a can of sliced peaches each day.

The AdVance procedure is often an outpatient surgery, but my surgeon kept me in the hospital overnight. My foley catheter came out the next morning. After drinking lots of water, in a couple hours I began voiding without problem. I'm wearing a Depend's underwear rather than briefs and a guard post-op, because the stitches are still in the portals that are at the thigh/perineum junction. The Depend underwear can be brought low and avoid rubbing.

I had significant pain during the night following the surgery, but nothing like what I experienced after the rad'ectomy two summers ago. Taking the pain medication that was offered while in the hospital really controlled the pain well. I went home the day after the surgery and haven't needed to use the pain medication (vicodin) at all. I wanted to avoid it if possible because it can lead to constipation. I've been taking ibuprofen. I haven't needed it for pain from the surgery, but for my back and hips from the excessive reclining that I've been forced to do.

Along with recommending a stool softener and fruit, I recommend getting a raised toilet seat. The surgeon kept warning about not squatting or straining. Our toilets are a bit low. I wanted to avoid getting too low and then straining to arise, so we got a raised toilet seat. It's working really well. It has handles on the side to be able to use your hands to assist in arising.

So, things are looking encouraging.

John,

I wish you the best and encourage you to continue to post regular updates on your progress. I suppose you have searched the site for others experience with slings and have probably seen mine. If not there are some links to my journey in my profile below if you are interested. I tried a Virtue sling that did not work and ended up with an AUS 800.

Carl

Thanks tallguy and Purgatory for the well wishes. tallguy, I had seen many of your posts in some of the other sling surgery threads. It was the threads here at healingwell that convinced me that there could be a positive outcome to surgical intervention.

Tomorrow will make three weeks since surgery. And despite my stupidity, I'm still dry. Funny how the body will move before brain engages. The day after my post on 15 June, before brain engaged, I found myself kneeling on one knee to free the dog who had wound his leash around a fragile table. He'd been somewhat freaked by all the noise of the dry wall guys here to repair the walls cut by the plumbers.

Saturday 18 June was my first day without wearing a diaper in two years. I'm using two of my wife's Kotex panty liners in my briefs, slightly overlapped to get greater lateral coverage.

I'd been wearing the Depend underwear post surgery. I wasn't leaking, but the incisions were so sensitive. I could pull the Depend low to avoid rubbing.

Sensation to the scrotum still returning. Hypersensitivity reducing.

Things coming along well.

Thanks again for the well wishes.

I'll give them a look. Thanks!

John,
You're dry! Hooray! Hopefully the discomfort will subside soon. It should over time. Six weeks is not that long and based on my experience with three surgeries that is about the point when things start getting back to more normal.
Good news!
carl

Yes, I'm pretty lucky on all levels. My cancer was caught early, and was eradicated with the rad'ectomy. The AdVance procedure is working. Thank you both for the encouraging words.

Hey JohnGPT
Congratualtions. I am 6 months ahead of you and still love it. I was a good boy throughout the healing process (leaving my wife to take care of the woodburning stove in the dead of winter.) I am now doing more physical activity - heavy lifting etc and find I do leak a bit. I wear half a Tena Serentiy Ultra Thins and that is more than enough to take care of me all day no matter what I'm doing. A half pad will hold 20 ml easy.

I tried to stretch out my bladder a bit by drinking and waiting before I really had to go. I am up to 500 ml capacity now.

How long does a visit to the urinal take you? It still takes me 2 1/2 minutes. It's worth the wait.

Stay dry,
Jeff

Jeff, John, glad to hear such good long term results. I'm a bit worried at the moment. Having been given yesterday the okay to lift 25 lbs, I lifted a case of Perrier at Costco and then also carried it from car into house today. Knowing that 1 gallon of water (3.78 L) weighs 8 lbs, I used the calculator on my cellphone to figure out that the case of 24 half liter bottles of Perrier weighs 25 lbs. So I thought that it would be all right.

This afternoon I've been having some strange sensations again, but no actual leakage. So maybe I dodged the bullet.

I think I'll wait some more before doing this again!

I had sensations like this in the first couple weeks after surgery, when I had knelt to free the dog who had wrapped his leash around a table. It turned out okay then.

I am scheduled for the Advance sling surgery in early October. I had a robotic prostatectomy in January of 2009 and I would rate myself as a "light" leaker. I use one and occasionally two pads per day. The urologist I am using has done hundreds of these procedures and believes I am an ideal candidate. My biggest test for the ultimate success for the sling will be during sex. I am fortunate in that my erections are basically back (despite the shortening of my penis...I didn't get that memo prior to the prostate surgery) and I don't want to continue to shot pee into a rag when I have an orgasm. An orgasm is the ultimate stress for stress incontinence. I went to a seminar on incontinence, at the town where I am on vacation, and the urologist was pushing the AMS 800 urethra clamp/bulb device. He said the had some experience with the AdVance sling and that "it didn't work." I asked for specific problems and he just said again, "It didn't work." He said the incisions are the same for both procedures and why not just put the clamp and associated plumbing in and be done with it. Doctors try to sell what they are familiar with and use most often. What's a fellow to do?

Does anyone have experience with the AdVance sling during sex? The recovery period seems to be critical to the success of the sling and the previously posted suggestions are great.

AdVance sling or AMS 800? Coin flip? 

I came back to write my semi-weekly update and noticed that a certain word in my reply to bizman42 has been asterisked out! Too funny.

Okay, this past Tuesday made seven weeks since surgery. I was originally scheduled to return to work this past week, on 18 July, but rescheduled to this coming Monday, the 25th. I'm glad I did. This week has made a big difference in my comfort level. The raised portions of the incision that I had described in my post on 09 July had continued to be a problem through most of the following week. But this week, things have been much better. There is very little sensitivity now. There aren't any raised portions of the incision now. The hypersensitivity of the scrotum is much less.

The increased urgency I described in my post on 14 July (darn, I forgot to wish everyone a Happy Bastille Day!) subsided in another day or so. I was able to sit through the newest Harry Potter movie yesterday without needing to go to the restroom. It's actually been years since I've been able to do that.

I've thought more about Jeff's question regarding how long it takes to pee. So I've timed things. It takes me 15 to 20 seconds to void 200 to 250 cc. Then it takes me another 15 to 25 seconds of shaking it out, trying to assure the last dribbles get gone.

I no longer need the raised toilet seat.

This coming Tuesday the 26th will make eight weeks post surgery.

I'd say if someone works at a desk, return to work could feasibly be accomplished at the the sixth or seventh week post sling procedure.

As a physical therapist working with outpatients who have orthopedic problems, my work is a combination of manual labor and paperwork. I'm not sure if I can remain within the 25 pound lifting limit. But I don't really have a choice. My extended leave time is depleted and I have to go back. I'll just have to be as cautious as possible.

John,
It's so great to hear you are on the road to recovery and are smelling great at end of day. Keep us informed on your progress.
Carl

I have arranged to have sling put in October 7th. 3 years and 5 days after surgery. Glad to read input from you guys who have taken the plunge.

What's the bottom line?

As I have indicated before, my sling procedure is scheduled for October 11, 2011 and I believe it is the less invasive and simpliest procedure for my light leaking, but it has to work and work well. After 50, every guy cannot get those last few drops of pee out and it ends up staining the underwear. That I can live with. What I don't want is to go through the pain and discomfort for something that might not work.

Are you confident the Advance sling is working and working well? Urologists that don't like the sling suggest the artifical sphincter but I can find no comparative analysis of the two.