Coaptite Injection for Incontinence, AUS next?

Hello Fellow Travelers,
I had a procedure to beef up the urethra with coaptite 3 weeks ago. Unfortunately it did not work.
I didn't mind trying and my urologist told my wife that he was able to get the material where he wanted it
and he was surprised at the 2 week post-op visit of no change in incontinence.
He told me it looks like I was headed for the AUS. He doesn't do that surgery but another guy in the practice
does and I have an appointment on July 7 to see him. He doesn't care for the sling for men.
I think I am ready. I lose 80-100ml daily with regular activity, sitting part of the time and standing part of
the time. When I walk my 4 miles in the morning, I lose everything (90-120ml).
Most of you that have had the AUS are happy, are you not?
Jess

Jess,

Although I am only two weeks post op...and Snother four weeks until activation, I can't speak to how it works yet, but it is my hope that this will indeed get back done much needed quality of life. The recovery hasnt been too bad, I am getting better every day, but no regrets so far. Good luck.

You're welcome, Jess. If you decide to go ahead with the AUS, I hope it works out as well for you as it did for me. If you want to know what the pre- and post-surgery experience is like from those who had the AUS implanted in them, all you have to do is ask in a posting. Or you can look up postings to this forum. WAORGANY is, I believe, the most recent poster to go through the surgery and I'm sure the experience is still fresh in his mind. Big Mac and Knotreel are another couple of guys who've had it done.

Good luck to you!

Mike

I had three injections of a bulking agent to improve incontinence The first injection was Macroplastique and the next two were Coaptite. I saw very little improvement after the first injection but was encouraged to try a second injection. There was improvement after the second injection in that leakage went from 7-9 ounces a day to around 5 ounces. I was again encouraged to try a third injection to provide further improvement. After the third injection, however, I was pretty much back to where I started. Even with a good outcome from a bulking agent, "tune-ups" are required in the future to maintain consistency. After the third injection, I was offered a sling procedure or a fourth injection with the doctor definitely indicating the sling as her preference. From my experience, I think introducing a bulking agent is an "iffy" procedure. Even if the perfect spot is chosen, there is the possibility of leakage and/or migration post-procedure. I am now using a Cunningham clamp with a pad when I am out and pads only at home.

Sorry to hear the bulking did not slow down the leakage. The reports I have seen usually report at least a temporary improvement. With your light leakage I would think you are a candidate for the sling as well as the AUS. I was not a candidate for the sling as I was (am) 100% incontinent. I got my AMS800 implanted in Jan 2011. At first it was 100% dry and I got use to that quick. Just like old times, no pad, no worries. That lasted about 6-8 months, or so, then I leaked so that one light pad per day was required. I then got evaluated for a revision about two years in and had a smaller cuff put in. It was only a couple of months and it was just like before the revision, one pad, guard actually, per day. So, for a heavy leaker like I was, I had too high expectations. It is very likely you will end up needing a pad of some type. However, you could possibly have the hoped for 100% dry result since you are starting off so much better off than I was. So, bottom line, don't expect 100%. I think you could expect a big improvement to the point of satisfaction with your result. Then, it could be that it will be better than that. Hope for that, expect somewhat less. I am very happy with my AUS and would get another if I needed it. You might have a good result with a sling as well but odds are the AUS will be a better result in terms of dryness. Still, there will be that little bulb you will have to squeeze to pee, that is something some people understandably have a major aversion to.

Your PSA is pretty much non-existent so if you have recurrence, it could be a long time off. I have a 20% chance of recurrence myself and knew I had to do something about my leaking first.

I would get the AUS and not worry about SRT in your future for now. Radiation will affect your continence so you need to get that fixed first. I asked my surgeon if radiation would affect the AUS. He said if it does, he could go back in an replace anything that may get damaged.

Now as far as your thumb, that presents another problem. I use my thumb and index finger to open the controller. You may see how long the healing time for that surgery and have it done first. It takes 6 weeks to have the AUS activated. If your thumb surgery heals quicker, you could have them done at the same time.

They could roll you from 1 operating room to the other and kill 2 birds with 1 stone. You would probably be the first to have that done!!!!

Moms said there'd be days like this, didn't she.

Congrats on your retirement. I retire at the end of next year and I also play the guitar.

Bill from Florida

Jess,

I wouldn't worry too much about recurrence until you have more PSAs done and see increases from one to the next. There's a threshold PSA above which one is supposed to start worrying about BCR but I don't know what it is. HW members who are more experienced than I am could advise you on that. But I think it's too soon to think about salvage radiation. You doctor can also advise you about affects on you AUS if that time comes.

Big Mac had some good advice on using the thumb for squeezing the bulb. Like him, I have to stabilize the bulb with my left hand while I squeeze the bulb with the thumb and index finger on my right hand. The doggone bulb just floats around in my scrotum and it can be difficult to grip - sort of like squeezing a peeled grape floating inside a water balloon! So, for me, it's not a matter of thumb strength - it's a problem of coordinating things through a series of steps: locate, stabilize and then squeeze. I don't need a real hard squeeze to open the cuff.

Mike

Good luck to you, Jess, in your discussion with your doctor, on your decision and on your procedure if you choose to go forward with the AUS. You may want to check in with PeterDisAbelard, who as I recall has had a slightly less satisfactory experience with the AUS than the guys who posted on your thread here. I can't recall the reasons he wasn't quite as happy with it but he can tell why.

Mike