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Incontinence-Male Sling System

Bob_S
Posts: 9
Joined: Oct 2005

I had my RP about 3 years ago and thank God I've been cancer free ever since. I do have a low to moderate problem of incontience averaging 2-3 pads a day. I've tried Kegels, diet and exercise and I think it's as good/bad as it's going to get without some form of surgery. I would like to be dry once again. I have Cystoscopy and Urodynamic tests scheduled to determine if I would be a candidate for an Invance Male Sling System manufactured by AMS. I've read the manufacturer's info on it and have talked with my Uro at Brigham & Women's in Boston. It sounds very promising. I would appreciate any independant information on this.

jweindel
Posts: 10
Joined: Jul 2004

Bob,

This is not my personal experience, and only the experience of one individual. One of our brethren in my Man-to-Man support group had the male sling procedure done about two and a half years post RP. Same deal as with you...2-3 pads per day. He was very unhappy with the sling. He had moderate to severe continuing pain after the procedure, and continued to have incontinence problems. He just recently had the AMS800 artificial sphincter installed, and so far is very happy with the results.

Again, this is just one man's experience with the sling. You will probably get many positive responses about it.

Good luck, whatever you decide.

Jerry

bajakid
Posts: 38
Joined: May 2006

Hi Bob. I had the Sling operation 3 months ago and for me it did not work. I should have tried collogen injections first.

Bob_S
Posts: 9
Joined: Oct 2005

I have had my Cystoscopy and Urodynamic tests and using the results my Uro and I decided on the InVance Sling System. He predicted a 92% effectiveness. Last week I had the operation, and the following is my post op status that I sent to my Uro:

Dear Dr. Steele,

It's been over a week now since you inserted my InVance Sling, and I'm delighted to say that I am 100% dry. It far exceeded my expectations. On the day of my proceedure I packed 6 pads to take care of my overnight. I never had to unpack them. I have not used or needed a pad since the day of my operation. I have not had the slightest drip or leak.
As instructed I have completed the 7 days of antibiotics, and have avioded heavy lifting. I've increased my walking every day. Yesterday I went to Newport, RI and walked 5 miles, had lunch with a friend, had a beer, and never bothered to bring pads. I was in total control. At this point the only the only discomfort I have is when I'm sitting on a hard chair, but that gets less and less each day. I'm on no pain medication whatsoever.
I have an appointment to see you in a couple of weeks so until then - Thank you, thank you, a thousand times thank you!

Bob

duque
Posts: 8
Joined: Sep 2006

I need to know about how painfull is the male sling surgery, and need some tips for after surgery

kemahbum
Posts: 1
Joined: Oct 2006

duque, I had the sling inplanted at MDA three weeks ago. I was 3-yrs post op, RP, going through 2-3 biggest pads a day (8 - 9 ounces urine each)...more if I consumed too much alcohol. I'm almost pad-free now. I use a very thin pad and they last 24 hrs. I may get a small dribble if I bend over w/full bladder or sneeze without clinching tight. For a couple of days after surgery I had difficulty voiding. Had to push really hard and it hurt like hell. I read that that is good. It indicates the sling is doing it's job and the effort required to void lessens after a couple of days. I still have to push hard, but the incision is healing and straining doesn't hurt now. Three weeks post-op, my problem is pain and numbness. Pain is moderate to severe and has not lessened to any degree. Staying on my feet is very uncomfortable and sitting doesn't work either. I feel best when lying down or sitting in my recliner. I've read that about 20 % of sling recipients suffer prolonged pain. I stopped the Vicaden after 10 days but would still benefit from it. I'm pleased so far...will be much happier when the pain and numbness subside. Unfortunately, I've read that a few surgeons report that after several years, some of their patients report that sling effectiveness is declining. I hope that is the result of bad technique and that my doc has the procedure mastered. She's done over a hundred and reports very good outcomes. She says that is due to MDA screening recipients very carefully to ensure that only good candidates receive the sling. I've read that poor patient screening is the biggest cause of unhappiness with the sling. Very heavy leakers appear to not do as well. I'd sure hate to have another doc cutting on me in that most sensitive area, but if my sling begins to fail over time, I'd probably suck it up and have an AUS device inplanted. I read that most surgeons report that the AUS can be inplanted along side the sling, with many leaving the sling intact. Hope this helps you. Like I say, so far I'm pleased with my result. I didn't handle my leakage very well. Let it really screw up my life.

tpelle
Posts: 150
Joined: Aug 2003

kemahbum: Thanks for your report. Is the pain and numbness the result of the entry surgery, the implanting (screws)of the sling, or something else? Which leads to the question, would the installation of the artificial sphincter (AMS 800) cause a repeat of this period of pain?

budman1
Posts: 1
Joined: Jun 2010

I will have the newest InVance sling implanted and pinned this next week. I was wondering if you are active or passive type of person?
I am 69 and have NOT ever quit doing very active things. I bowl 20-25 gamesw a week and do al my own yard and house work.I also am building walkway with cobblestone pavers.
I would like to know if You are dry ??
Thanks, in advance,

Budman1
prpfman123@yahoo.com

AZJIM
Posts: 1
Joined: May 2010

My sling worked very well for about 8 weeks and then slowly started to deteriorate as I became more active. I'm now only 20-25% better than pre-op. I'm considering a revision. Hate being wet!
Good luck!
AZJIM

lion1
Posts: 240
Joined: May 2007

AZJIM,

This is very distribing to hear. Do you mind telling me who your Doctor was? I appreciate your input. Myself and a few others I have been talking to, have the same concerns regarding these procedures. Take for instance this Dr McCammons in Virginia, supposedly very good, has a web site touting the SLING and a few patients who have overwhelming success, however, these appear to be older gentleman and they are not very active. You mentioned things were fine until you became more active. Also, what's going on with the other 100 or so patients Dr Mccammons operated on??

I know we all slow down when we get older, but I just turned 50 and am very active. I have been incontinent for 4 yrs. If I had one of these surgeries, I would want the Doc to reassure me that I could get back to almost normal life and not fear the pain and discomfort from another surgery.

Incontinence does stink but can you add some perspective to this for me?

Lion1

Skid Row Tom's picture
Skid Row Tom
Posts: 118
Joined: Apr 2010

For what it's worth, my local urologist and my doctor at Johns Hopkins both discouraged me from resolving my incontinence with the male sling. They said the procedure is much more successful on women. Searching the Internet, I found a lot of research and anecdotal evidence to support their concerns. Injections had no effect (although I did not have the "minimum" of 5), and made the decision to go with the artificial urinary sphincter (AUS) which I was constantly told was the "gold standard". The decision and the procedure was painful, but it resolved about 95% of my incontinence, and with the help of a daily liner to catch a few dribbles, I can lead a "normal" life.

lion1
Posts: 240
Joined: May 2007

Tom,

Thanks for your valuable input. Additionally, I was reading that many times doctors recommend a Sling, but if a person like myself has a contracting bladder, the Sling may be the wrong surgery and thus be put through much un-needed pain and not correct the problem.

Lion1

Tom58
Posts: 1
Joined: Apr 2010

Bob,
What I would give to go back to my pre-sling, 2-3 pads a day. I had the operation over a year ago. The doctor managed to destroy my uretha. I am now completely incontinent 15-20 pads a day.
My urethra had to be rebuilt with a piece cut from the inside of my cheek and I have constant pain. I can only tell you my experiance. If I were you I would not get the operation. period!

Trew
Posts: 892
Joined: Jan 2010

Started with a new uro today. We discussed the sling and the AMS 800 sphincter. My new uro does not like the sling- says it has too many kinks still to be worked out- just too knew. He spoke highly of the AMS 800 sphincter. I am set up for an eval about getting one myself. I want to go out backpacking and do more serious exercise and wear a swim suit without the fear of embrassing myself. PC has already messed up my life- I might as well toss fate to the wind and the care of God and see if I can't get something or a normal life back.

To restate: I am afraid of the sling.

fathersson's picture
fathersson
Posts: 121
Joined: Nov 2009

Had a year ago and NG.. Perhaps it was the surgeon?

Trew
Posts: 892
Joined: Jan 2010

I think it's a complicated device that really takes a lot of experience to install. From what I can find out the artifical sphincter has a much higher success rate.

lion1
Posts: 240
Joined: May 2007

Trew,

I am equally concerned about the Sling, because this Dr McCammons in Virginia is heavily touting this surgery and is doing many---he has a web site and there's just a few guys on there, telling their experience and it's all positive. I want to here from the other 100 guys who had it---how are they doing? McCammons is supposed to be very good-----but I really want to know how good he is from the other patients???????

Lion1

Trew
Posts: 892
Joined: Jan 2010

2- 3 pads a day for me right now. this looks like at least a 3 pad day for me right now. On thos days I may only use 1 or 2 days I think- hey- I am doing much better! and then the next day its 3 or maybe 4 pads. So somehthing needs to be done.

Now, that is the hard part- deciding on where and who is going to do the surgery.

I have ruled the sling out.

iam144
Posts: 3
Joined: Apr 2010

I had the sling (along with a penile prosthesis) installed just over a month ago and I don't think it's working out quite right.

They sent me home with a foley catheter, because I couldn't void. A week later the pulled the catheter at the urology clinic, with a "fill and pull" and said I was good to go. That night, it's back to the ER because I couldn't void hardly at all and the pressure was building up in my bladder. Back to the foley for another week until I could get into see my Uro.

This time when he pulled the foley, I hung around the hospital where my Uro has the clinic for a couple hours, and I could feel that I wasn't voiding properly. So he did a dilation (on the bladder? on the sling?) and sent me home with intermittent catehters.

The screwy part is that along with the retention, I have a bad case of urge incontenence. When I gotta go...I gotta go! However I only get out about 150 ml at a time before it just shuts off. I do an intermittent cath 3x a day, and doing that right after voiding, I get 150 to 250 ml out with the cath.

On my last visit, he says he wants to do a bladder study and cystoscope (is that right?) but that's not until mid-June. In the meantime, we are waiting to see if I get any better.

From what I've read in the various groups, I think I should have held out for the AUS. Hopefully, having the sling installed won't disqualify me for the AUS later if that's what's necessary.

My only concern is the pump. I already have the pump for the implant, adding yet another device in the scrotum might be problematic. To quote an old joke: "Confusis says: baseball very funny game, no man can walk with 4 balls!"

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

My surgeon has been installing a sling during the Robotic Surgery for about three years now. I got one and I know it's not the one that everyone has had issues with. I cannot remember the name but posted it here once. I know they attach it to the Coopers ligament and I have had not one issue with it or pain of any kind...and am continent except when drinking alcohol. I have been lax about my keggles and will start again because I notice pressure squirts occassionaly like getting off my John Deere lawn tractor. Here's the profile on me for anyone who has not yet seen it.

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores

11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%

Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined

Da Vinci performed 12/29/09 - Dr. Hollensbee & Scott
Sling installed at time of Da Vinci – not sure what name of it is but not the 800 that is causing all the problems. Attached to Coopers Ligament.

Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNo, pMX
All nerves sparred - found two additional pudendal arteries

FIRST PSA TEST 2-11-10 <0.1 NONDETECTABLE

Virtually Pad free 2-20-10

Next PSA scheduled for 5-26 Results 6-2-10

Notes on Recovery: Was at my desk working (from home office – sales) 6 days following my surgery. No pain to speak of (very lucky as many have some pain) I think because I took the Tramadol they gave religiously and found it to be the best drug in the world. BM’s where the trickiest part and most uncomfortable in the early stages but improved with time – follow the diet they give you!...I strayed off and the next BM helped to get me back on track – I like food very hot and spicy - don’t recommend that for at least a month following surgery. Cream soups, mushroom, celery, and chicken worked great the first week following surgery. Mashed Potatoes…Ah the first time following surgery it was heaven!...the first really solid food I ate…..you will learn to appreciate food all over again as you add back your favorites following surgery when the time is right. Take all the help from everyone around you…it might be a while you get that opportunity again to be waited on hand and foot. Liquids are a concern but some affect people differently it seems reading through the discussion board…I found anything carbonated would cause much leaking…alcohol was not good either…but I justified doing it thinking It’s my training method to work on my bladder control!...lol I love homebrewed beers too much! And am an admitted hop head.

ED path:
Early on started on Viagra 100mg pills cut into 4ths so 25mg per day dose then a full 100mg on every 7th day.
Also bought pump and used sporadically to get blood flow to member. Within about three weeks or 5 weeks from surgery (cannot remember but probably posted on CSN somewhere) had usable erections.

Currently only need ¼ pill to get usable .

Randy in Indy

canuckwonder
Posts: 3
Joined: Mar 2011

Sorry about your "sling" experience. Mine was totally great. There are two kinds of slings, Invance and Advance. The Invance is the earlier application, the Advance is the newest. Both by the same medical company. Invance uses securement by internal titanium screws, the Advance uses a loop or ligament securement. Some patients incurred pain with the screws, this due to improper placement (installing the screw on a nerve).
The key is (as for any surgery), you have to be an "IDEAL" candidate. Ie, 2-3 pads per day, good cystoscopy results and no previous urological complications. Also, get a doctor who has done many of the sling procedures. AMS Medical Systems (company that makes the slings) has a list of doctors all over the US that do these procedures.

Trew
Posts: 892
Joined: Jan 2010

Bob S, I had the urodynamic testing done today. You do have my sympathy that you have to have such a procedure. I posted a few details under the thread on the 800 Sphincter.

I am definitely not interested in the sling.

canuckwonder
Posts: 3
Joined: Mar 2011

Sorry about your "sling" experience. Mine was totally great. There are two kinds of slings, Invance and Advance. The Invance is the earlier application, the Advance is the newest. Both by the same medical company. Invance uses securement by internal titanium screws, the Advance uses a loop or ligament securement. Some patients incurred pain with the screws, this due to improper placement (installing the screw on a nerve).
The key is (as for any surgery), you have to be an "IDEAL" candidate. Ie, 2-3 pads per day, good cystoscopy results and no previous urological complications. Also, get a doctor who has done many of the sling procedures. AMS Medical Systems (company that makes the slings) has a list of doctors all over the US that do these procedures.

bimini1
Posts: 1
Joined: Apr 2011

I had prostate surgery, Di Vinci method 18 months ago. Cancer all gone so far. PSA tests every 4 months 0.01. I am told by my Dr. Gregg Lovallo that I am a perfect canidat for the sling (whatever that means).Wearing 2 to 4 Depends a day, more when I go to Happy Hour. Any suggestions? I am reading here both good and bad results on the AdVance sling system. All feedback will help. I am new to this site. Thanks

kreinholt's picture
kreinholt
Posts: 35
Joined: Mar 2009

I am 50 yo and after almost two years of kegals and incontinence (3 to 4 full pads a day + occasional accidents), I finally had enough. I went to my urologist and asked about the sling. He indicated that the sling was for more of the slow leaker and would not be as effective for someone who leaked like I did. We then discussed the artificial sphincter. I opted for that procedure and had it done last November 2010. I love it! I can wear one pad for days if not weeks. I change everyday just because and have not yet tried to go without. I'm probably too used to wearing one at this point. My quality of life has improved 100% and I am looking forward to using it this summer during my outdoor activities. I no longer worry about being on my feet for long periods of time and no longer carry any extra pads, just in case I need to change. I no longer worry about that. When I need to relieve my bladder, I have to physically squeeze a small bulb in my scrotum which opens the cuff around my urethra, releasing the urine. It is not hard to do or uncomfortable and works great. I have on occasion, stood in front of the urinal like I did before my RP and when nothing comes out finally realize that I need to squeeze the tube. I feel almost normal again. I would tell you to consider this option if the sling isn’t for you.

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