AdVance sling 31 May 2011

I had the Advance male sling installed yesterday afternoon at the Univ. of Texas Southwestern Medical Center in Dallas, TX by Dr. Allen Morey (a reconstructive urologist who has done over 100 Advance slings). I had a robotic-assisted radical prostatectomy in January 2009 (age 60) at USMD in Arlington, TX and had a prolonged ileus as a major complication (10 days in the hospital). Either bladder spasms or suture failure allowed urine to leak into my abdominal cavity causing my bowels to shutdown for several days. I had a catheter in place for six weeks and my stress incontinence had leveled off at between one and two pads per day. I have been on that rate for over a year and a half. My original urologist suggested the InVance sling (screws), but friends and others all had problems with continuing pain from the bone screws and the sling eventually failed. I believe the artificial sphincter was over-kill and decided the least-invasive and best choice at this date was the Advance sling.

The surgery took 30 minutes and the doctor said my tissues, structure and urethra was in very good shape and the installation went as advertised. Considering my history with the ileus, this was very good news. As I awakened in the recovery room, I felt very little discomfort and had to move to my legs and waist to confirm that I did indeed have surgical wounds. It hurt when I moved but not much. I asked the nurse if the doctor had used Lidocain to further dull sensations and she said that he did. I was in the recovery room for 2 hours waiting for a room and never felt much pain. Just prior to moving from the gurney to a rolling bed, I received a IV shot of Dilaudid to help in the transition. After several hours in my room, I was stunned at how little pain I felt. The dilaudid had worn off and I didn't feel I needed any other pain medication. After dinner, I was able to get up and walk the hall with little difficulty. I took a Vicodin at 9:00pm thinking it would help me sleep, but I didn't need it for pain.

This morning the catheter was removed after I had loaded up on coffee, apple juice and water for breakfast. about an hour later, with high hopes and some fear, I went to the bathroom to try and pee. To my surprise and relief, a steady stream started easily but not as full as I had been peeing before. I filled 375ml and felt great. My next event produced 400ml and the final test 390ml. Success.

I was discharged at noon and I haven't felt the need for any other pain medication. I'm still awaiting the first bowel movement but I have been on stool softeners and have a raised seat. After peeing, and shaking, I dabbed the tip with tissue and I haven't leaked. I'm sitting comfortably at home and stunned that the procedure went so well with so little discomfort and no pain worth noting. Several men have warned that recovery can be rapid and the chances of doing something stupid before six weeks increases. I understand that now.

So far, so good. 

Last night the soreness was a bit more and I found sleeping on my side with a pillow between my legs a great idea. This morning I was more sore than yesterday but not painfully so. It feels as though I have had a groin muscle pull on both sides. The incision site itself is tender but not painful. I took two Tylenol in the middle of the night after peeing but didn't notice much relief and went back to sleep anyway. Took a shower this morning and had minor spotting of blood when I dried the incision.

I have no problem urinating and the stream is good enough to void my bladder in fairly short order. I "tug" my penis several times to get all the urine out I can. It's amazing how much I can pump out when my bladder feels empty. I slept in briefs last night and not a drop slipped out.  I find I cannot squeeze the last drop out as this is uncomfortable and the Kegel muscles aren't back on the job yet. I am just wearing briefs, for support, and no pads. Haven't leaked a drop yet.

I developed a hernia at the trocar site just above the belly button from the robotic surgery and had that repaired in February. I developed an impacted bowel after that surgery and I have taken stool softners for several days now to avoid that problem from recurring. Haven't had a bowel movement yet but I'm feeling the rumblings. Hopefully, all will flow well. That's when I will breathe easier. 

Already, I have been tempted to pick up stuff I shouldn't. It's going to be tough not to do anything for six weeks. At this rate, I'll feel quite normal by next week. However, I understand the key to success with the sling is being a good boy for the full six weeks. 

I'm able to sit in a cushioned easy chair with little discomfort.

What's the adage? "Prior planning prevents piss poor performance."

I knew I had had a problem with anethesia and constipation from my prior hernia surgery and was resolved to fix the problem this time. I was on stool softners for two days prior to the surgery on the pills were working as advertised. I was eating grapes and other foods that were guaranteed to keep me loose and continued the stool softners up until this morning. Unfortunately, all was for naught. I became impacted today and had a very difficult time getting the first bowel movement to cooperate properly. In retrospect, maybe I shouldn't have eaten steak the night before surgery. My wife was just trying to be nice.

Around noon, I received a call from a nurse at United Healthcare who wanted to follow up on my surgery.  I told her I was concerned that I hadn't had a bowel movement as yet and I was afraid of becoming impacted. She suggested drinking more fluids, eating more fiber and taking stool softners. Check, check and check. But, I had the feeling that my body was already trying to eliminate but couldn't. For the next several hours, I was in and out of the bathroom, up and down on the elevated seat, grunting and groaning and getting nowhere.  I called the doctor's office at 4:30 and the nurse suggested an enema. I had a few surgical gloves and did some probing earlier and felt the impaction. Fortunately, after several hours of trying to eliminate on my own, the enema took about 2 minutes to clear me out. Yes, it was better than an orgasm! At least at this stage of my adventure. I should have called the doctor's office earlier.

The good news? Throughout the whole ordeal, I didn't leak at all. I didn't allow myself to push very hard (didn't have the muscle strength to push too hard anyway) and was careful not too bend over or strain too much, but I was exerting myself much more than I wanted.

The constipation was the main source of discomfort today. My testicles are still swollen but not overly tender and the incision is the same as yesterday. I was told to wear briefs for support, however the elastic bands that run on either side of the scrotum were rubbing the entry points of the curved needles and it felt raw and irritated. I have switched to boxers and I'm much better.

I'm back on track and feel very good now that I'm past the constipation hurdle. Next time, it's a liquid diet at least 24 hours before any surgery. Next surgery? Screw that!

Jeff, if it wasn't for the space in the bag, he would have made the NY trip