Decision made- AUS (Artificial Urinary Sphincter) being installed next month

Well I went to see a urologist today to discuss having an Advance Sling but after visiting with him, I decided to have an AUS instead.
He offered to do either but used the "Gold Standard" phrase when describing the AUS. Having had DaVinci, I am a sucker for the "Gold Standard" being used for procedures.

Now I don't want to start getting you "rad guys" cranked up so just calm down!

The doctor I interviewed taught both my urologist and my surgeon, Dr. Patel so I feel very confident in him and his advice. He has performed over 400 AUS surgeries and takes only 45 minutes to install them, the same time for a Sling.

I am 19 months out from surgery and still using 3-4 pads a day. 2 days ago I used 7 pads, the first time that I have gone thru that many pads in a day in almost 1 year. I guess I won't be swimming in Sonny's new pool next week at the GFMPH Orlando.

Anyone out there who has had this surgery that can give me some help with recovery, please chime in. How long out of work, how long before driving, etc. would be grateful.

Bill from Florida

Hey Jeff,
It was usually more than 200mil per day and double that a couple of days ago. Usually when I am working, I am on my feet all day, I am a sales consultant. I don't even feel like I need to go but I feel that warm feeling we all know before I even can think about it. I have better control at home but none at work.

I don't like guns! I'm not a numbers guy like you but I can tolerate a lot.

Don't try to talk me out of it! I have finally gotten to the point where I cannot tolerate any more and half measures are not acceptable.

As far as the "Big Mac", that is what my wife used to call me. These days it is more like "Little Mac"' but that is just another SE I am dealing with.

Bill from Florida

I'm not going to talk you out of it. That sounds like the way to go. I was told a max of 200 ml per day and minimum of 3-5 seconds for control is needed for good sling results. It appears you don't meet those criteria. I was right on the edge.

One of the guys here had an AUS, and pump installed at the same time so he could max out his insurance. He has been pleased with the results. He joked that he had 2 bulbs installed and, to avoid confusion, he had them labelled: "Come" and "Go". He's a riot. We met in Baton Rouge at Cajun Jeff's GFMPH. ;-)
Jeff

To answer Jeff's questions as a reply to you, I too did not measure ml or even pads. It didn't seem relevant as while on my feet all leaked out, I never needed to pee except at night or if sitting for an extended period. Sounds like something you have? I was able to stop and hold urination the few times I actually peed (at night) and this was done fairly easily. I did go incontinence therapy so my pelvic floor muscles were pumped! However my sphincter did not stay closed unless I consciously maintained the pressure. I was only about 10 months out from DaVinci when I when to Dr. Boone, an incontinence specialist at Methodist Houston and he preformed a uro dynamics and cystoscopy. The uro dynamics showed how much pressure my sphincter could hold and the cystoscopy reviled no causes like a growth or scar tissue. It also appeared to show the sphincter as misshapen and not fully closed but the water pressure form the scope probably blew it open some. Anyway, he said that he did not recommend the sling in my case and that even though it was only 10 months there was not need waiting to see if it would get resolved. Oh, and I am "that guy", "come and go". I should add that after my decision to schedule the AUS I decided to have the penile implant done at the same time. Hence "come and go" that was a joke of Dr. Boone's, and I didn't actually have a tattoo. Just some sticky notes. As Peter points out insurance will pay if your ED is a result of the Pca. It did. So, pain that's not an easy question as the IPP was done and I think 90% or maybe 100% of the pain was from that. I just had a smaller urethral cuff fitted and that was practically zero pain. Dr. Boone does not insert the reservoir through the scrotum into you lower abdomen so that calls for an incision in your low abdomen which in my case was only a very little bit sore. This same incision also was used for the IPP reservoir as well. If you want to have the IPP with this surgery or on it's own, I think 1 week would be the minimum that you would be able to return to work and if on your feet a lot, you should allow for 2 weeks just to be sure. I wont go into the detail of the IPP recovery unless you ask, since that was not your question.
My AUS was 100% effective most of the first year then I started wearing a "shield" type of pad maybe 1/8" thick. I hoped not to wear any at all so I had the cuff revision this past August and I still have to wear a shield, never more than 1 per day. Dr. Boonewasn'tt that keen on the revision and said it was "50/50" but I as greedy for 100%. Should have listened as probably my result was the usual, not the 100% I started out with. The pump an tubing in your scrotum is not uncomfortable and having to pump open the cuff is not bad either.
I am very pleased at the result, going from 100% incontinent to almost 100% continent is big. Oh, and unlike Jeff, I can pee 200ml in less than 5 seconds!
I hope your's will be all the way 100% but like me, almost 100% will be great. One doesn't know how much incontinence can affect you life unless you have it. Good luck.
Ron

My experience was very similar to Ron only I did not have the IPP. I did have a sling installed first and it did no good at all. I should have listened to my Uro and went straight to the AUS gold standard.

I am very pleased with my AUS but like Ron I still use one pad per day. I have not gone for a smaller cuff but may consider it if I start to leak more. The one pad keeps my quality of life great and comfortable. Some guys get closer to 100% dry with AUS but we and our Uros are all different.

Also agree you should be able to go back to work in a week. Perhaps two if on your feet all day. Us mature guys tucker out sooner but you are a kid of 63 and I am now 70.

You are making the right decision.

Big Mac
knotreel Ron, is the guy I referred to in my earlier post. To respect his privacy I did not feel comfortable posting his name without his prior permission.
He is the man! I watched his results closely as I was considering an implant. I even got as far as being measured up - but I chickened out. My adult film career is over before it started.

Ron, Thanks for checking in! I hope you are doing well.
Jeff

I don't think I explained the tattoo joke properly, it was "come" the side where the IPP pump is and "go" on the AUS pump side. It was a doctors joke and I looked to see after the operation, no they didn't, whew.
In spite of his sense of humor, my doctor is pretty conservative in his approach, six weeks before he activated the AUS, some do it sooner.
I was all about having just one operation and one recovery and to tell the truth I don't know if I would have gotten the IPP on it's own. I am glad I did now but being 100% incontinent during recovery and then having your penis and everything else swollen, the wearing of pads was difficult. I didn't think about that and it quickly became a situation. So, your not going for both, saves the additional difficulty of dealing with incontinence while the IPP is healing and your body is getting used to it's new part. I hope you will keep us updated on your operation.
Ron