Ed's AdVance Male Sling Procedure

Hello Ed

This is my first time in this forum. I am 56 years old, had radical prostate surgery in 2003 and has had incontinence since. I use 2 pads a day and can walk or run with out a problem. I will be having the Advance Male Sling surgery Nov. 10, 2010. I have read all of the material and researched the different surgeries and I feel I have chosen the right one for me. I asked my doctor if sexual performance would be affected by the surgery and he said no. While reading all of the different emails from people who have had this surgery and the other types of surgeries, no one has mentioned this, so I ask all those who read my letter, how is your sexual performance after surgery? My wife would like to know.

    

rwrich21

Plenty of stuff on hw about slings. Be sure you read it all. Sounds like you need to get the incontinence fixed first and then worry about your other issue. Docs do not tell us about all the risks but then we often to ask all the questions.
You may need to travel. Seems like the Advance has pretty much replaced tHe InVance......especially if you are only a one pad a day guy. Get a second opinion even if you need to travel to do it.

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.

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 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.

Grettings, I am brand new and considering sling or cuff implantation.

Yep robot prostatectomy July 2010. Leak forever since.

Heck no, it is NOT stress inconinence as Dr. calls it.

It is PFNFR incontinence. Pee For No F in Reason.

To all: the reason we pee is the surgeons remove your bladder neck sphincter your proximal sphincter. You are left with ONLY the urethral sphincter (distal sphincter) THAT is why they want you to do Kegels etc.

See that balder neck spincter is held always tightly closed by your autonomic nerves you can NOT force it to open ever until your bladder fills enough, then the nerves tell your brain "ok we need to empty" only after that signal happens can you go to a urinal, what a moment then the let-down happens as your BRAIN sends signals to 1) open your bladder neck sphincter and 2) contract your entire bladder muscles so you can pee. Also then to pee YOU Voluntarily relax your secondeary sphincter (the urethral sphincter). That secondary sphincter they leave you with is the one that you can start and stop the urine flow, makes the sausage dance for your wife and is used in sexual activity and orgasm.

Doc never told me I would drip pee all day, 3-4pads a day at least an ounce build unless I play my trumpet thenm, oh my does it fill.

Doc told me I would have "dry orgasms" after prostatectomy.

NOPE he lied again. I shoot pee when I orgasm.

My wife does not like my pee dripping out during attempts at sex, dripping on her, in her in her mouth, on the bed on the floor.

It is worse when I am in any "I am upright position" but still drips out when I am flat on my back and my secondary/urethral sphincter pulses.

(which it is supposed to do when you engage in sexual play)

Well of couse you will, cause your bladder neck sphincter is gone, your entire urethra had pee in it and that secondary sphincter when you pulse it, pee shoots out in little jets.

That's why GOD gave you a bladder neck sphincter in the first palce.

So yes Docs to NOT tell us the truth the whole truth and nothing but the truth.

SOOOOO I am scared of another operation.

Sling, advance or invance? Aus Cuff?

I dont want to do both surgerys.

If I am doing one than it needs to stop my pee and I dont ever wear pads. Cause if you do not have pad or diapers on and then you pee I am kinda screwed. So that means I would need to always wear a pad "just in case".  So why bother with all the surgery if we still need to wear a pad for "just in case".

Really looking for insight from all you experienced guys here.

It is so great to hear the truth instead of the BS from surgeons and doctors.

Thanks to all.

I was diagnosed with cancer of the prostate in July of 2010. 3/ 6 biopsies were malignant.  10% of prostate.  Clear  report after surgery as all cancer was removed.  Last test 7/2012 was .057 PSA.  Had a laporoscopic prostatectomy on November 2, 2010.  This was performed by a very capable doctor by the name of Dr. Gilad Amiel  from Scott Dept. of Urology at Baylor in Houston, TX. After surgery, I was catheterized for 7 days removing it on Novermber the 9th in doctor's office.  (Great relief)  I recuperated and returned to work 4 weeks later.  (I returned to work too early and should have waited an additional 2 weeks as I still did not feel up to par.)  I elected to take 2 weeks vacation for recovery totaling a 6 week recovery.  After the 6 weeks recoup, I felt really well and was able to return back to an active lifestyle.  Due to incontinence, I was forced to wear 3-5 pads a day  intially, due to my incontinence.  Over the course of two years it went from 3- 5 pads to 1-2 pads/ day depending on liquid intake and the amount of exercise I did for that particular day.  For an hour of strenuous exercise, I would totally soak a new pad.  It became frustrating especially not being able to feel when you were going and totally soaking the pad and underwear in the most unfavorable places.  ha! This became so frustrating that I set up and appointment with Dr. Amiel who recommended I talk to Dr. Christopher Smith (another urologist) at the same location to see if I would qualify for an Advance Male Sling.   I then visited Dr. Smith who performed an in office cystoscopy and determined that I was qualified for the sling.  I scheduled and had the surgery done on October 5, 2012.  I must add that he has performed many of these sling installations which is why I felt very comfortable to go through with the operation.  Post surgery wasn't so great much to my chagrine.  I stayed overnight in hospital and had to leave with a catherter due to inablility to urinate.  I was released on Saturday Oct 6 and went back to office on Tuesday Oct. 9 and had catheter removed.  All seemed well on the 2 hour trip home.  That night I could not urinate AT ALL!  Had to go to emergency room and have cathetier reinserted draining 1800cc's over a period of one hour.  Amazing!  I returned to dr office on Thursday and had catheter removed.  Dr. instructed me how to self catheter and I returned home.  Was able to self catheter and urinate slightly on my own for a few days.  (125cc catheter/ 80-100cc regular)  Dr. Smth had me come back in on Tuesday Oct 16 for a sling adjustment'..  Worst pain you can ever imagine! Method is:  a metal tool about the size of a pencil with a bend on the end is inserted into the penis and pried against the sling to allow more flow.  He then inserts the cystoscope camera in to see if any good was done. Pain med is only lidocane.  After that a catheter was reinserted to allow for swelling to subside.  I continued to self catheter for about three to four additional days.  Good news out of all of this is, after three weeks, I no longer need to self catheter and my urine stream seems to be getting stronger and frequency has waned.  Most of all I am pleased to report, no pads and completely dry even during a bit of restricted exercise.  No major weight lifting as of yet, still have about   3 weeks for that.  I do recommend however, that after the two week mark, try to stretch a little as it does help the tension on the sling, if you are having a bit of trouble urinating.  Sorry so long on the history.  If you have any questions, feel free to ask.  I would go through it all again and highly recommend the sling.  Feels normal, except strong flow which I feel it will return.    

Had AMS surgery on 11/06/2012 , the U of Chicago Medical Center . Dr. Bales that done my surgery have done over a thousands of them. I stay over night in the hospital .
On the everning of 11/07/2012 , I started urinating at 1800 hrs . Before I was discharge,
I was shows how to do self-catheterizaion,and was given instruction to do it every night
at bed time , until I get less than a hundreds . So far I am completly dry and most
I don't have that urgency to go .
I will see my doctor on 11/26/2012 ,and I will follow his advise to a T.

BW64,

Welcome to the forum. I've started a new thread for you so folks can say hello and offer you advice and encouragement.

Your thread is here: www.healingwell.com/community/default.aspx?f=35&m=3137791