My artificial urinary sphincter was "activated" Monday morning, ten days ago, and I suppose I owe those of you following my progress an update. When he turned on my device, my urologist told me that it usually takes a few days for the cuff to compress the urethra so it works properly. If that Monday was "Day 1" with the device then I am starting Day 11 and I guess it is time for a somewhat preliminary report.
I spent the first few days working on readjusting my expectations. The reports I have read on patient satisfaction with the devices generally consider "improvement" and "zero
to one pads a day" as success. I have to confess to having hoped to be instantly magically dry when the device was turned on and that didn't happen. So the first few leaky days were spent working on my expectations.
But, after the first few days I decided that "one pad" a day is too vague a measure. I was wearing "Depends" and, while one a day was quite sufficient, those guys will hold up to 250 ml which is heavy leaking in anybody's book, so I needed a better measure and I started weighing my pads again. Here are my results:
Friday (Day 5): 197.7 ml
Saturday (Day 6) 151.5 ml
Sunday (Day 7) 130.7 ml
Monday (Day 8) 80.0 ml
Tuesday (Day 9) 61.9 ml
Wednesday (Yesterday, Day 10) 101.5 ml.
With the exception of yesterday the trend is encouraging but I still leak quite a bit -- frankly, more that I hoped to. As for yesterday, I dunno. I did let the dog rush me. If I had taken time to pee
before I took the dog for her evening walk I might have done better. But, still, it broke my trend and was sort of disappointing.
If you read my surgeon's report (which I previously posted
in another thread) you will see that he installed two cuffs during the procedure. The first cuff was placed as near to the bladder as possible but proved to be too tight (he could not pass a catheter or a cystoscope with the device deactivated) so he
opened me back up and placed a slightly larger cuff a bit further down the urethra where it was a bit thinner (and possibly less damaged by my radiation.) I speculate that either of these adjustments -- a bigger cuff or a different position for the cuff -- might have sufficed (no way to know) and the combination of both corrections may have left the cuff a bit loose. But I dunno.
One thing I have noticed is that since my activation Kegels are not my friend. The pelvic floor contractions that we learn to do as Kegel exercises do two things: they contract the urinary sphincter and they also contract the bulbospongiosus muscle which compresses the bulbar urethra. These two functions share the same nerve fibers and it is difficult to do one without the other. The contraction of the bulbospongiosus muscle is intended to expell the last bit or urine in the urethra to prevent the "post micturation dribble" which too many of us are familiar with.
What I have noticed is that each Kegel contraction produces a pretty good squirt, even with my cuff closed. My theory is that since my cuff is somewhat separated from my natural sphincter a certain amount of urine will tend to be in the bit of urethra between the two sphincters (the natural and the artificial) and that when I do a Kegel contraction it clamps shut the natural sphincter and compresses the bulbar urethra, forcing the urine through the cuff and causing a noticeable squirt. With a bit of patience I am convinced that I could Kegel a full bladder empty without
opening the cuff but it would take a while.
Unfortunately, in addition to the voluntary contraction of a Kegel, the same contractions happen involuntarily when one sneezes or coughs or tries to hold back a fart. I also seem to leak when I get out of my car -- same compression of the bulbar urethra externally applied by the edge of the seat -- and if I let my bladder get too full.
But the overall trend is positive, as shown by the scale with which I weigh my pads, and I am trying to reserve judgement for a while yet, but I have to confess to being disappointed at this point. We'll see.
As for the penile implant, I am reserving judgement there, too. Mostly I am waiting to see how things wind up with the AUS. I will say that I think my surgeon was a bit timid in his measurement. Because I have regularly used trimix and a VED up to my surgery I have a pretty clear idea of the size of my corpus cavernosa (my venous leak prevented
maintaining an erection with trimix but I could
achieve one as long as I stood up.) During the operation he measured me at 21 cm. I'm pretty sure he could have gone with 23 or even 24. 21 cm (8 inches, more or less) sounds sufficient but you have to remember that the back end of the implant slots into the pubic bone and over half of that length is inside the body.
I am sort of waiting to see how things settle out with the AUS before I give the Mrs. a tour of my new bionics, so she will know what's available.
Wish I could give a more upbeat update. These devices have really good satisfaction rates -- 80 percent or better -- and I would hate to put anyone off. But I guess somebody has to be in that grumpy 20 percent. I was sort of hoping it wouldn't be me this time. But we'll see.