Slings and Radiation (Changed my mind. Going with an AUS).

Let me set the scene for you: Mrs DisAbelard and I are cuddling on the couch. The wine is red, but cool and slightly sweet like she likes it. A warm fire crackles in the grate. I stand up to put another log on the fire and, while my back is turned, I give that old third testicle a quiet squeeze or two...

I contend that if I have managed to incorporate the pump for my yet-to-be-installed implant into my sexual reveries then I am not wildly averse to having mechanical gizmos in my scrotum. But I have to admit that I am irrationally attached to the idea of a sling instead of an artificial sphincter.

They have done studies of men given the choice between a sling and an AUS and, even when the surgeon strongly recommends an AUS, something like a third of the guys so advised will still go with a sling. I understand the lure of the sling. I feel it. In my case it is not so much that I mind the idea of having some hydraulic controls for my bionics that I will have to futz with to pee. It is more being cross with medical science that they can't fix what they broke.

I have an appointment with my surgeon tomorrow at which I will probably pull the trigger on starting the scheduling process for my three-way upgrade -- AUS/Sling, Implant, and Umbilical Hernia Repair. The hernia is starting to bug me (I am wearing a truss as I type this) and that provides a reason to up the tempo a bit although I will probably still wait until after the holidays.

In the past he and I have talked about both slings as sphincters as possibilities and I have been stewing about which I should ask for given a choice. (Which I may not be given.) I've been weighing my pads for the last year and a half (graph) and my leaking is more or less within the range that a sling can handle (up to 400 ml a day). Over the whole period I've averaged 117 ml but its been going up. In the last six months I've averaged 173 ml and I do have occasional excursions into the 500s on days when I spent the whole day unloading furniture from a truck, or similar activities. But I am mostly in an OK range, leakage-wise.

More of a problem is my adjuvant radiation after my RP. I think the most common sling used these days is the "Advance" sling which has admirable success stats except with men who have had prior radiation. For men who've been radiated the Advance Sling seems to really, really suck (failure rate something like 80%). So that sling is just out, I think. But there are other slings on the market that don't rely on repositioning the urethra forward that seem to do better. And there are other "compression" devices that don't call themselves slings that seem to work, too. So I dunno.

The sensible thing to do, of course, is opt for an AUS. But the lure of the sling tempts me, like Steinbeck's "song of the pearl", to irrationality.

So, anyone here have a sling installed after radiation? Other thoughts?

Oh, and another thing... I am easily confused and I worry that if I give the wrong testicle a squeeze I might put out that fire.


Update: (Spoiler alert) In the end I decided to go ahead with an AMS 800 artificial urinary sphincter which was implanted on March 5th, 2015. As of this update (twelve days later) it remains deactivated until I heal enough to mess with the controls (in another month or so).

I have been advised by two Urogists, one an incontinence specialist, that the sling is definitely a no no for me, partly because of my volume of leakage, averaging 300mls per day, but particularly because of adjuvant radiation. My understanding, which is possibly very flawed, is that the sling relies on being absorbed into the bone structures within the pelvis, and radiation results in low to zero absorption occurring.

I'd be very happy if anyone could elaborate more scientifically.

I have other issues re the AUS which I will post separately after I have had todays cystoscopy as part of my evaluation for an AUS, but it is not looking good.

I have also spoken to one person who had both an implant and an AUS and asked him if there was ever an issue with pressing the wrong button and he assured me that was very unlikely.

PDA, I envy your degree of leakage. I rarely have a day under 200 mls and can usually expect one day a week around 500mls. My record so far is 630mls.

Am having to completely avoid coffee and alcohol and have restricted fluid intake to one cup of decaf tea per day and the rest water only.

Good luck with your choice. I trust you will soon be dry and actively amorous.

Chas

PDA,

I asked my doctor if radiation would be a problem for my AUS if and when I had to have it. He said no, the worst thing is he would have to go back in and replace a tube, balloon, etc. All they would have to do is de-activate it and have another out-patient surgery to replace the "burnt out part".

I know that doesn't necessarily answer YOUR question but may help others, like me, who are waiting for "the other shoe to drop" and may have to have radiation AFTER and AUS is installed.

Good luck on your visit tomorrow. Good way to start out the New Year with a 3-way fixer upper!

Bill from Florida

I talked to my surgeon today and I am fairly sure I have set the wheels in motion to do something. After talking to the doctor, mostly about the relative merits of slings and sphincters, I sat with his scheduler to work out when such things could be done. After discussing my nephew's wedding, houseguests for Thanksgiving, a scheduled trip to Manhattan for work, Christmas, a Trip to Orlando with the grandkids in January, and the schedule of not just my urologist (who is pretty booked up) but also the surgeon who will do the hernia repair and a cardiologist to do my stress test to certify that I will probably live through the operation... after all that I am a bit vague about what I was scheduling.

But here's what I think we are doing... I'm pretty sure... I think...

I did decide to go with an Advance Sling and an AMS 700 lgx penile implant. We talked about the problem that my radiation poses and agreed that it does make it less likely that the sling will be sufficient although my surgeon thinks the odds I found in my research are too dire. He sees it as more or less 50/50. But that gives me a 50% chance of getting what I want and the surgery for a sling is less difficult and the recovery is easier and it is less expensive (not sure if that last part matters with my out-of-pocket cap). If I am not happy with continence with the sling I can add an AUS later.

I have seen several studies that suggest that the combination works well for most guys with intractable incontinence. Here are a couple of representative ones.

Combination options with the male urethral sling to treating post-prostatectomy incontinence

Salvage therapy with artificial urinary sphincter after Advance™ male sling failure for post-prostatectomy incontinence: a first clinical experience

PDA,
I agree with knotreel, congratulation on making a decision. You will wonder why you waited so long to do it after the soreness is over.

Ron helped support me a lot with my AUS and of course Worried Guy Jeff is the "go to man" for slings.

Bill from Florida

Peter,

Your leakage numbers are very similar to mine and when I saw the Uro who specialises in continence and strictures, he immediately said "too much for a sling", so I am sure you have made the right decision.

From all that I have read, the sling has a much higher failure rate than the AUS which is regarded as the "Gold Standard".

Good luck, I am very envious. Gotta wait for up to 12 months until my stricture has been fixed before I can look at an AUS.

I have no advice but this was funny --> "Oh, and another thing... I am easily confused and I worry that if I give the wrong testicle a squeeze I might put out that fire."

Never had I accidently pumped the wrong "testicle" But thought about it more than once.. However I really liked the ;

" Mrs DisAbelard and I are cuddling on the couch. The wine is red, but cool and slightly sweet like she likes it. A warm fire crackles in the grate. I stand up to put another log on the fire and, while my back is turned, I give that old third testicle a quiet squeeze or two..."

How romantic!! Ha.. What would be even better if it was a joint exercise!!

Now I do not have but would like one, My wife does not even like sticking her hand down there knowing I have an AUS implant. Something really cooled the fire when all of this happened. Same situation I think goes on with trimex..the "impulse" situations goes out the door. All of it requires too much planning.. Even with the AUS, gottal clean up, trash the pad.... not the same.

I am glad Peter, you are putting much thought into all of this.. I never looked back, am very happy to be fairly (yes fairly, not completely) dry. It still can leak and does. But a big change from before.

NEO

One of the reasons I married my wife is because of her keen sense of humor. When this subject came up as a possibility in my future (hopefully a remote one); she joked she might could press the button while I sleep and wouldn't even have to bother to wake me when she came to bed.....(I go down at 11 and she stays up til 1 or so...)

That's a major bunch of surgery.

Hope the recovery goes well, and even more hope for a really successful outcome - HARD and DRY!!

Chas