Pro and Con Advice Regarding the AdVance Male Sling from Implanted Users or Urology Surgeons

I'm a healthy, active 75 year old male. I had a heart stent implanted in 2006 and am under the watchful eye of my cardiologist. I got his medical release for DaVinci prostate surgery that was performed on 2 Dec 2011. It was successful as you can read below. At 4 weeks post surgery, I did develop a DVT (deep vein thrombosis) that broke loose and moved to my lungs, resulting in a PE (pulmonary embolism) that immediately put me back in the hospital for six days on heparin to help dissolve the lung clot. I was then on coumadin for 6 months. I'm clear now but also under the watchful eye of my pulmonologist. Because of my 30 years of jogging and exercise, I passed my recent lung tests with flying colors. Both my cardiologist and my pulmonologist will clear me for any future surgery that I my require, subject to their review and approval.

At 18 months, the only problem that I have is 1-3 pads a day for my incontinence. I do not have ED. I do not believe more time or therapy will make me dry. But I have places to go and things to do and pads make it miserable.

Therefore, I am considering either a male sling or the AMS 800 artificial urinary sphincter (AUS). I know the AUS is the Gold Standard, but I'm concerned that in 10-15 years, will I be able to properly manipulate it. I don't want my wife or a caregiver to have that responsibility. Or to have someone accidentally try to insert a catheter without my being aware.

Regarding slings, the Coloplast Virtue, looks good technically, but my urologist doesn't recomend it because of various problems that it has experienced and I have read about. I wouldn't feel comfortable with that choice.

That leaves the AMS' InVance and AdVance slings. I asked my surgeon if the new AdVanceXP is available. He checked with AMS and found that it is approved in Canada, but hasn't yet received US FDA approval. He feels that it may offer slightly better "tissue grab" for the arms, but likes the standard Advance just fine. He has done well over 100 male slings and several hundred female slings. He claims his result are 90-95% successful and I spoke to one of his recent patients the same age and conditions as me and he was very happy with his results. I don't like the bone screws that are required of the InVance.

My new urologist is not the same surgeon that did my prostate surgery because my original doctor does not do slings and AUS'. He comes highly recommended by members of my prostate support groups, tho.

It may seem that I have made up my mind, but I haven't. Even staying with my incontinence pads remains an option. I would like feedback from others who have experience with slings and AUS. This is a major health and quality of life issue with me.

Thank you,
Scouter194

Others can comment on the sling, and from what I hear it might be all you need. I had total incontinence, so the AUS seemed the best choice for me. After the AUS I went from total incontinence to 100% continent. It was done 1/11/11 and gradually it has lost some of it's effectiveness so that now I wear a light liner pad and one during the day covers the problem. I think the cuff around my urethra has atrophied my urethra somewhat. At some point I may consider a cuff replacement to tighten the squeeze. I don't think operating the pump should be a concern as it is very easy to do requiring finger so little pressure that you could do as long as you had use of your hands. A small child could operate it easily.

However, you concern about a catheter being placed while you had "no say so" is a valid concern, even the wrong size could cause problems, they like big ones in the hospital generally and you would need a smaller one probably placed by a uro or uro nurse.

 

logoslidat

What does a reply of "bump" mean?

scouter194

bump means that someone, logistat in this case, noticed that no one had replied to your post and just replied in that way to "bump" your post up higher on the list to make it more visible.

I think the Advance sling might be your best choice, but the cytoscopy should give a pretty good idea of what kind of candidate you'd be for it. I've heard horror stories about the Virtue sling and some not-so-good stories about the Invance sling.

At 2-3 pads a day, the AUS might be overkill. If after the cytoscopy your doc still thinks the Advance sling is best for you, I'd go with his advice. However, I'm a little skeptical about the 90-95 percent success rate claim. I think it's closer to two-thirds, but it clearly works well for a lot of guys, and those still aren't bad odds. My results in the long run were only so-so, but when it works well it's a life-changer. If I had it to do over again, I'd still take a chance on it.

Good luck, whatever you decide. I know how frustrating this can be, and I hope you get your life changed.

Jonathan

Scouter, your issues seem very similar to mine. I had open prostate surgery 3 years ago and came away cancer free, suffered only temporary ED but after 2 years still leaked between 2-4 pads a day. After complaining to my Urologist what a nuisance the leakage was he referred me to a sling specialist. After a cytoscopy and urodynamics I was considered a good candidate for the Advance sling and elected to go that route based on my own research and the results of others in this forum. My surgeon said his success rate after doing over 100 was about 70% dry or very close to it.

 I had the Advance sling installed in Nov 2012  and have not leaked a drop since...a total life changing event. I can do anything I wish, lift, ride my bike, walk, run...you get the idea. Prior to the sling I had to cut back on many of the activities I did, walks with my wife, hiking, swimming, you name it, the list goes on. Not sure how active you are but the sling also improved my sexual relationship back to pre-cancer days, wow, I thought I'd never see that...what a blessing and I privately thank the surgeon often for restoring a great relationship back to a more fulfilling great relationship.

 Carrying and changing pads was always an issue when out with friends or family, I'm sure you're familiar. I used to dread the thought of an all day fishing trip on the lake with my best friend because I wasn't sure how long I could go on 1 pad. My quality of life is no different now than pre cancer days and I often mention to my wife how incredible such a simple procedure has been and what a difference it has made.

Yesterday I hopped on my motorcycle for a ride with a friend and was looking for a tool in the sidebag when I stumbled on a cache of pads from last summer, I smiled and decided to leave them there in case I need something to wipe up oil with and to remind myself of just how different life is to be dry.

I hope this helps, I did post a long thread on my sling surgery recovery, if you're interested I'll look it up for you. The sling surgery recovery was actually more difficult for me than the prostate surgery, everyone seems to be different.

Good luck with your decision process and please feel free to ask any questions you may have.

Ron

 

Post Edited (Arch) : 4/30/2013 5:00:41 PM (GMT-6)

Arch
Your post, along with the several other posts and the research I've done, has led me to my decision. Thanks so much to each of you. Weighing everything, I've opted for the AdVance sling. Dr. Greg Barm'e will perform the surgery and my prostate surgeon, Dr. Erik Pasin, plans to assist, as long as it fits in with his schedule. Pasin does Da Vinci surgeries and AUS', but has not done slings to date. I made this suggestion and they both think it's a good idea. They know each other professionally and are in the same large medical group, Urology Specialists of Southern California. Pasin will remain my primary urologist. Let's see how it goes.

BTW, I had my cystoscopy yesterday and Dr. Barm'e said it looked very good. I viewed it in HD video. Very smooth urethra and healthy-looking bladder. He noted that my anastomosis location could not be distinguished from the rest of my urethra. Dr. Pasin had done a good job removing my prostate. The sphincter also looked good to me from a distance, but as he moved the camera closer, I could see the very small opening at the center of the sphincter, my leak point. It looked like an old-type camera shutter that didn't quite close completely. Then, as he too-easily pushed through the sphincter to view my bladder, he said, "Weak sphincter, but the sling should fix that".

Outpatient surgery is scheduled for July 1, 2013 at Hoag Hospital. A catheter will be inserted for the short operation duration and out the next am. I know I'm going to hate that part the most. I'll keep this thread posted of my progress and results.

scouter 194

Hi ja from mry,
Very interesting! Especially your revised kegel program and your progress. Note that I've delayed my operation for two months. I did this intentionally. Is there still a chance to regain continence without surgery???
I don't think I would be interested in being an early user for stem cell trials. It seems like a promising, but long road to FDA approval.

I still do my kegels regularly and several months ago I did an 8 week program with an "expert" incontinence therapist, but to no avail. The bio feedback part of that program included at each session sticking a sensor up my butt that displayed on a computer screen when and how strongly my anus sphincter closed. I did very well on that test and she thought my incontinence would quickly be corrected. Disappointingly, no improvement was noted.
I have since wondered why it is professionally judged that an anus sphincter closure will accurately reflect a corresponding closure of my urethra sphincter. It may simply be that a sensor cannot be easily placed that will directly verify urethra sphincter closure, and since the anus is nearby, that's good enough. I really don't know or understand the rationale.

Recently, I came across a series of YouTube videos conducted by Australian physical therapist, Michelle Kenway, demonstrating how to do kegels (both women and men). I've tried her technique and plan to continue until my surgery date or until real progress in my incontinence indicates a sufficient light at the end of the tunnel to cause me to delay surgery further. My uros both agree that regaining continence the natural way would be best.
Kenway's technique is to imagine one's pelvic floor muscles as a hammock between your hip bones with a small weight at the bottom center that you want to lift. Then, standing sitting, or laying on your back or side, try to slowly squeeze and suck-up the imaginary weight into your abdomen using only those bottom, internal muscles. Don't use your outer muscles. You should feel some upward movement of your pelvis.
We'll see if that helps.

As I'm typing this, my cardiologist just called to give me medical release for the sling operation without further testing because of the minor nature of the operation. Yea!!

ja, I'd like to hear more about your revised kegel program and try your exercises.

scouter194

Curious George said...
I am 12 weeks post sling (AMS Advance). At this point, it's the best thing that I've done since PCa raised its ugly head. Surgery itself was easy, though I had a hard time getting rid of the catheter. So far, not a single drop of stress leakage. No pads - period. There are several prior posts here (including mine) about sling experiences. I would suggest checking them out. I intend to post further after my 90 day follow up at the end of May.

Somebody said...
thanks I am consider the Advance your post is encouraging

hello scooter this is 2018 I would really like to know your progress I'm considering the advance sling nothing else works I'm down to one pad a day but my urologist thanks I can be cured fully with the sling procedure if you come back to this thread please shoot me a response better known as tone you better know it

I got the sling 3 rd day very difficult to pee through

Good luck knot