Deciding Between Sling and AUS: What constitutes "due diligence"?

Sometime during the next six months (dictated by my insurance company's fiscal year) I will probably have either a sling or an AUS put in and, barring miracles, do an implant at the same time. I am two years and three months out of surgery, one year and nine months out of adjuvant radiation, and two months out of ADT. I leak anywhere between 40 and 400 ml a day depending on how much of my day is spent sitting and how much is spent doing yard work. I am dry at night and mostly dry in the mornings but get leakier and leakier during the day. I guess it is stress incontinence -- if putting your hand under the warm water tap to test its temperature counts as stress.

I've talked to my surgeon about getting dry and he likes a sling for me. I'm a bit over the usual cut-off leakage for slings but I am a big guy and big guys leak big. Based on interviewing me about my leakage and a cystoscopy in which he liked the look of my sphincter he thinks a sling will work.

I'm tempted to just take his word for it and go ahead. I'd really rather have a sling than an AUS. Someday my shriveled testes may return from hibernation and I'd love to have room in my scrotum for them. And when they work, slings are more natural. In order to pee you just step up to the pot and pee.

Problem is, it's hard to convince myself that I am doing my due diligence. Other guys talk about "urodynamics" and other sciencey-sounding 5hit when making the Sling/AUS decision, and I'm not sure that going to my same urologist and having him peer at my sphincter -- "Looks sling-able to me" -- is all I ought to do.

Given that I live in central North Carolina and work makes extended medical travel unhandy, is there someone else I should talk to?

I don't know much on the subject, but from your description, I'd say you've got it well thought out all ready.

Maybe you could write yourself a detailed engineering report covering the use, pros, cons of the different systems to prove to yourself you know more about this than you're giving yourself credit for.

Sadly, the only person I know in that area of the world is you and I don't think you can operate on yourself (some federal law as I recall).

Andrew

I wonder too, as it was told to me by the doctor that did my AUS ( an incontinence specialist), the urodymanics that he does establishes the pressure that a patient's bladder can hold and from that he can establish what pressure that AUS must provide to hold back the flow. The AMS800 AUS uses four different reservoir pressure rating and based on the data chooses the appropriate one. So, apparently some doctors must feel confident to guess all this? If I didn't know this from my AUS experience then I wouldn't be worried. However.......
Maybe you should look for an incontinence specialist. Teddydog said it, " a prudent step". My doctor was recommended to me but failing that I would seek out a large university teaching hospital in your area. My AUS doctor is with UT Methodist at the Houston Medical center and another doctor tag teamed with him to perform the IPP. The IPP doctor was With Baylor U. in the Scott Urology dept. The late doctor Scott basically invented these devises, both! Getting the right fit with the IPP is a big issue.

PS. the AUS was recommended based on the Urodymanics test, up till then I was thinking sling.

Yeah, I just don't know! You leak 400 some days? Hmmmm.

Like you, I'd rather have a sling if it would get the job done. But will it at 400? Sounds to me like some fancy smancy testing might be called for. You don't want to do a sling if there are high odds it won't get er done. Does your surgeon do both?

I think about things like this possibly for the future. But, what will MCare pay for? They won't pay for a penile implant, will they? If they won't, I won't be getting it, no way to pay for that huge bill.

knotreel said...
Yes, medicare pays for both implants, if they are needed as a result of the Pca. Crazy, huh?

It is crazy since they won't pay a penny for my rehab Cialis. I even pay for part D through Wellcare drug. When you apply, they ask you what drugs you are on, then tell you what your cost will be after copays/deductables etc. They said they would cover some of it but not all. Then after I enrolled, I got their book with all the details and I see that Cialis requires prior approval, by them. But they have refused to approve it for any reason. I have not had the time or energy to fight them on it. I'll just change companies next year, just on principle, I'm sure no one will cover it.

I believe Wellcare says MC won't allow paying for Cialis or Viagra, but they will pay for an implant? Yep, sounds like government alright.
Bill

Bill,

You are right. It's time to do something. The sling/AUS decision is proving fairly difficult. I am OK with my surgeon doing it but I would like a bit more science to help me decide so I am shopping for second opinions so I don't wind up like the mule that starved to death standing between two piles of hay.

While Googling for local doctors who are known for this sort of stuff I came across this study from Duke where they reported an admirable success rate with AUSes installed on men who had previously failed with a sling.

www.ncbi.nlm.nih.gov/pubmed/22503016

For what I really want, see the thread I just bumped: My Device (A Modest Proposal). And, if you think I am kidding about starving between the two bales of hay, note the date. I posted that two years ago and I still haven't figured out what I really want to do.

PDA, I am now 13 months post surgery and subsequent radiation and am still very incontinent.

I recently spoke to my Uro and he agreed that I needed some intervention. At that time he said that I would not be a candidate for a sling as I had undergone radiation and also suffered from strictures (subsequently dilated, but now recurring). I didn't question him as it seemed logical that I would need a more drastic solution, so not sure why radiation would affect the sling. Can only imagine that the bone structures within the pelvis, and to which the sling would be attached, may be compromised by the radiation.

While my Uro has done both slings and sphincters, he said I should be treated by a Uro specialising in incontinence treatments because of the complications. Consequently I am booked with a surgeon in Sydney who is one of the stricture and sphincter kings in Australia. At this stage that booking is purely for evaluation, but hoping for the go ahead for a sphincter.

Good luck with your decision.

Chas

Just got back from a cruise. It was the first time I had to use public urinals, on the ship. The bathrooms were small and sometimes the handicap stalls were being used. I usually go into the handicap stall so I could drop my drawers to reach the controller. Really no problem at all. As Tallguy said, "it's no big deal".

Bill from Florida

Carl that is part of my problem, I don't wear boxers so I have a difficult time "handling things" without pulling them down out the way.

Thanks for all your help over these past 5 months.

Now we have to get PDA to join our exclusive AUS Club.

Bill from Florida

I might as well chime in on this. Been looking at the post from the start.

I did not have any "pre" testing on my situation. I just peed all over the place as was tired of having to run to the bathroom @ work (while tending to a client and pee was puddling on the floor at my feet) or my condom cath slipped off, or I woke up to find my bed was wet, or or or or or...

I did all the exercises asked of me. I knew my external sphincter was shot as I leaked around the Foley Cath as well when I had to have it.

I do not think I was a candidate for the sling, though I thought of it. That will be your choice. However since I am a big guy also, this I do know and found out.

Disclaimer, I have a Neo-Bladder that does not stretch like normal bladder. So when I get to point in time, the fullness will over-ride my AUS and I will leak.

If I sleep on my back or belly, I put pressure on the AUS @ the two hour mark. I can push out the urine from either the belly fat pushing down on my bladder or if I sleep on by fat belly, the same happens. So I sleep on my side for the most part. I can sleep for several hours on my back or belly, but as the neo-bladder fills, it will push out at some point in time.

I feel if I had a sling, it would happen much earlier. A lot less resistance in that device. The same goes for heavy activity. How well does a sling work if your are active? Bending, walking/running and so on.

The AUS is not perfect by any means in these areas also, but, good enough for me to do all of the above, with minimal leaking. Note, I did not say "with out any leaking" because you will. But I can function, and only I know what I am doing. I get buy with one heavy Depends Pad for Men, but I also shove in a folded paper towel and replace during the day to catch the small leaks to keep the pad dry and not smelly as the day goes on.


NEO