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Advanced Sling Surgery

bbsc
Posts: 1
Joined: Oct 2012

I have been advised to consider the Advanced Sling Surgery to, hopefully, eliminate an incontinence problem I have had since RRP approximately 4 1/2 years ago. I currently use 2 pads/24 hours (a good day and most days). Everything seems to be working fine otherwise. Does anyone have any suggestions or comments? The surgeon is with a highly rated research hospital in the SE USA.

tpelle
Posts: 161
Joined: Aug 2003

Thanks for your post, bbsc. After ten years of <.01 PSA since radical prostate surgery and continuing 2+ Depends pads/da usage (average 8 fl oz/da drippage), my urologist/surgeon is referring me (at my request) to a surgeon who is on the American Medical Systems "Find a Surgeon" list and is a Professor and Vice Chair of a Univ of Calif Med facility. My drippage seems to be similar to others who have described their issues on this forum -- no drippage at nite, no drippage while sitting, but drippage all the time while standing to the point that the bladder is empty after a shopping trip, garden work, treadmill walking, etc. At almost age 81, my family obligations now permit me to explore if I would qualify primarily for an AdVance Sling or even the AUS 800. My request for an appointment is in process and I'm hoping to get an initial visit with the surgeon within the next several weeks. The on-line literature seems to indicate that the AdVance is helpful for those who have stress incontinence -- those who leak as a result of coughing, sneezing, heavy lifting and the like. I haven't seen where the AdVance is particularly suited for those who leak continuously while standing. I will be anxious to see your further reports and comments from others on this subject. tpelle

lion1
Posts: 240
Joined: May 2007

If I was only using 2 pads a day and had no other issues. I would be soooo happy. Right now 5 pads a day--------incontinent 7 years.

I am a very active 52 yr old. But, if your lifestyle is not really heavily active and you want to be completely dry, then it may be the thing to do. Please research the complications though. Sounds like life is pretty good for you now.

Also do you have sphincter problems or overactive bladder??? or Both?

Lion1

limpndamp
Posts: 7
Joined: Oct 2012

I will share my experience with the Advance Sling.

I had Davinci RP in Feb-10. Was down to one slightly used pad per day by Dec-10, so doctor and I decided to have the sling implanted in the hope that it would keep me completely dry. I would classify my incontinence as the stress-type only. I was dry at night and throughout most of the day. Playing golf posed the greatest leakage, due to the use of the core muscles during the swing. But even after 18 holes, the pad was not even half used.

For several days after the sling surgery, I had to self-catheterize due to swelling of the urethra. About ten days after the surgery, I had two completely dry days. Thought I had reached the promised land. The next day, after leaving work, I had to make a couple stops to run errands. Well, by the time I got home, I was soaked. I've been leaking ever since at a rate twice as much as before the sling. The doc who did the implant says I must have moved the sling when I was self-cathing.

Not satisfied with that response (BTW, I no longer see him), I went to Duke. The doctors there told me it was highly unlikely I moved the sling, and that it was probably mis-placed during the install surgery. They recommend that I have an AUS implanted. (They talked about a "secondary" sling, but said they are not having very good results with it, so they don't recommend it.) I am still considering the AUS option.

Moral of the story:
1) Things can "backfire". Make sure you understand the odds of a successful outcome. While I was at Duke, the doctors told me that in the PCa business, one is considered "socially continent" if you only use one pad per day or less. This allows them to quote high success statistics, even though there is still leakage. Make sure you understand what the doctor is telling you.
2) Go to the experts. I still kick myself in the ass for not going to Duke to begin with.

lychee
Posts: 5
Joined: Nov 2012

Hello I had DaVinci RP seven years ago and after 3 years I had a Advance Sling installed without much help. 5 years after RP my cancer came back and I was treated with Proton Therapy. 2 years after Proton my sphincter got worse 5 pads per day and I had a ASU installed on Nov.2011 6 months after this operation I am “Social Continence” One large gard pad will last all day if I work hard or light pad if not. I am a happy 74 year old with my one pad and would recommend this operation to anyone, As for the bulb in my sack it is not noticeable from the inside or out side. After a few months I have learned to step up to the Urinal with the other guys, The technique I use is to lift my sack over the top of my shorts which controls the aiming angle so I can use both hand to squeeze the bulb.My ASU bulb placement is at the very top right hand side of my sack. The reason for two hands is the bulb very slippery inside the sack, one light touch will open it for flow. I use Tri Mix to take care of my other friend down there. Would be happy to answer any questions and give info on my Dr. in South Fla. Lychee
.

bigxbadxjohn3
Posts: 20
Joined: Dec 2009

I was implanted with a Virtue sling July 2009. It was a total nightmare. It made my light incontinence MUCH worse and caused pain and suffering which has never ended.

A portion of the Virtue sling was removed December 2009 and I was implanted with an AdVance sling near the completion of this explant procedure. The AdVance sling has been fantastic. I continue to be 100% dry following nine years of wearing pads.

The lower arms of the Virtue sling, which remain under my pelvic bones, causes intolerable pain when seated. It feels like I have rough steel cables imbedded in my tissue which becomes compressed and painful anytime I sit.

I have had no success finding a qualified and agreeable surgeon to remove this pain causing mesh from my body.

Fortunately the AdVance sling's mesh does not wrap around the lower pubic ramis bones which should eliminate the possibility its mesh causing the sitting pain that I experience.

Best wishes,

John

tpelle
Posts: 161
Joined: Aug 2003

BBJ: Good hearing from you again, particularly your continuing success with AdVance. I'm seeing the Vice Chair of Urology at a U.C.Med Center on December 10 to find out if I qualify for AdVance, or even AUS 800 if that's what he recommends. I'm still at <.01 PSA and 2+ Depends pads per day of constant drippage -- average 8 fl oz/da. What I hate most, last week a relative and I sat at the computer looking at numerous photos he had taken on a trip to Europe. So engrossed in what we were doing I forgot about the pad filling. When we got up, not only was my pad soaked, but my pants too. Happening too often and I'm determined to explore a possible solution. Thanks for your update. tpelle

bigxbadxjohn3
Posts: 20
Joined: Dec 2009

Hello tpelle,

You may be a good candidate for the AdVance sling with your light-medium pad usage. Beyond your assessment to learn if you are a good candidate, learning your surgeon's experiences and successes with male slings is of great importance. Be certain to ask all the critical questions.

Best wishes,

John

billmac22
Posts: 7
Joined: Dec 2012

I had a radical prostatectomy in January 2012. After making progress for a while, I seemed to be stuck at three to four briefs per day, so it was suggested that I try male sling surgery. That was done on November 14. For two days post surgery, I was almost dry, but then I regressed, and am now far more incontinent that I was before the surgery. I dribble all the time. I went out for dinner with a new brief on, and within 2.5 hours I had saturated the briefs and wet my pants.

I was warned that some patients did not benefit, but I wasn't warned that some were made worse. I'm very discouraged.

tpelle
Posts: 161
Joined: Aug 2003

bill: Thanks for sharing your experience. Did your surgeon implant the AdVance Sling made by the American Medical Systems? How experienced was your surgeon using the particular sling he selected and was he approved by AMS? Did he tell you that there are several sling systems? Did he tell you the percentage of his sling implants which were successful, to me meaning dry or using one light pad? I'm seeing the Vice Chair of Urology at a U.C.Med Center next Monday. Per your experience, one of my many questions will be "how often will a sling make incontinence worse?" I am already leaking (dribbling) any time I am standing and even to some extent while I am sitting. Yet, my average daily leakage over the last twelve weeks is 7.5 oz per day using about 2.3 Depends pads per day. Sometime I get engrossed in a computer project and forget to hit the bathroom until it's too late, soaking the pad and my pants. For ten years I haven't been going to extended dinners, the theatre, ball games or similar away-from-home functions. I'm hoping there is some relief. Thanks again for relating your experience. tpelle

billmac22
Posts: 7
Joined: Dec 2012

I don't know what brand of sling he implanted, and I wasn't smart enough to ask. He didn't tell me that there were several sling systems. I feel stupid for not doing my homework. I did a lot of homework selecting the surgeon who did the robot-assisted RP. His web site claimed that just 3% of his patients were still wet after a year. We didn't wait quite a year, but he didn't think I was going to get better by waiting a couple more months. I guess I'm in that elite 3%.

The surgeon who did my RP is Vice Chair of Urology at UCI Med Center. He referred me to another urologist in the department and told me that the guy had a lot of experience implanting slings. That person told me that 75% of his implants were successful. He said nothing about patients getting worse.

I guess the next step is the cuff around my urethra and a ball to squeeze in my scrotum every time I want to urinate. Aside for my distaste at the thought of it, I'm wondering whether I want to once more risk being in the small percentage of patients who were not helped and in fact made worse.

At the two-week followup appointment after the sling surgery, bulking injections were mentioned at a possibility for the future. I have three books that I reference, and they say bulking injections are not a sure thing either, and sometimes they even make it worse. And even if they do work, they have to be repeated every 6 to 18 months. I don't know if I'm man enough to take a needle up the penis very often.

I feel like I'm between the rock and the proverbial hard place. If I had it to do over again, I might have gone for watchful waiting. At least I would had quality of life for a while.

tpelle
Posts: 161
Joined: Aug 2003

Thanks, bill. Your comments are most helpful to me and probably many others. I'm seeing the UCDavis Med Ctr Vice Chair of Urology on December 10. I had open RPS in 2003 and have been a 2+ Depends Pad user almost ever since.

Recently my surgeon (not UCMed) told me that the incontinence rate of his patients is 2-3% which is consistent with what your surgeon told you. It was he who referred me to UCMed for consultation. From all I've read about Slings, the percentage of success isn't much over 50% and then there is the question as to what is determined to be success. Some guys are dry, some have reduced pad usage, and some, like you, make no progress and even regress.

I prefer the AMS AdVance Sling system. I don't know what I will do if he recommends the AMS AUS 800 Artificial Sphincter. Again from what I read the success of the AUS 800 (urethra cuff) is much greater and the chances are good you wouldn't again be in the 3%. I tried the bulking agent a few years back and that didn't work for me. What did work to some extent is the anti-depressant med Imipramine in about half the dose when it is used as an anti-depressant. But, the side effects -- dry mouth, constipation, jittery, nightmares, insomnia, etc. etc. -- are difficult to live with.

Watchful waiting is good for an older person and when the cancer is slow-growing. I was older (71 at surgery) but, the urologist couldn't tell me it was slow-growing. It's taken me ten years to at least confer with a Incontinence specialist. I'll let you know the results of my consultation next week. Again, thanks. I lived in Turtle Rock for a number of years. tpelle

billmac22
Posts: 7
Joined: Dec 2012

For what its worth, here is a link for the surgeon who did my robot assisted RP.

http://www.urology.uci.edu/prostate/index.html

I had just turned 73 when I had the RP. Maybe I'm too old. In his book, Surviving Prostate Cancer, Dr. Patrick Walsh, one of the pioneers of nerve sparing RP, uses age 70 as a rough cutoff age for treatment and for type of treatment. First, will the patient live long enough to benefit from treatment. And then if he does treat, is the patient strong enough to withstand the rigors of surgery.

But four different doctors including my cardiologist told me that I was not the typical over-70 patient. I run, ride a bike, use a rowing machine, and lift weights in order to be able to continue my hobby, which is free-dive spearfishing. My resting heart rate is around 40 bpm. They all said I was likely to live long enough for the cancer to get me before something else did. Even the radiation guy that I went to for a second opinion told me that while he would be glad to treat me, he thought I was a good candidate for surgery. My surgeon told me that he wouldn't operate on anyone that he didn't think would benefit from treatment.

I don't even have a good way to contact the surgeon who did the sling. All I can do is leave a voicemail with his supervising nurse and hope she gets back to me. But on Friday I did email two of my RP surgeon's assistants, telling them that I wanted to let him know how his referral for sling surgery was working out. One of them returned my call an hour ago and said that the doctor was at a conference in Germany, but they had forwarded my email to him. That is ironic, since I just cancelled a trip to Germany to see my daughter at Christmas. I don't want to be trapped on an aircraft with the seat belt light on wetting my pants.

But anyway, I asked her about brand of sling, and she said she would contact the sling surgeon for that information and get back to me. I'll pass that along when I get it. She did mention that while he was an incontinence specialist, most of his patients were women. I'm not sure how significant that is, but I wish I had known it up front.

As a retired Marine I hate to admit to cowardice, but where the bulking injections painful?

I suppose that the AUS 800 is my last best hope, but I wonder how long I'd have to wait recovering from the sling surgery before I did it. I timed the sling surgery to give me time to recover and try to get back in shape for the beginning of the spearfishing season in March. If I did the AUS 800, would that wipe out one of the few seasons I have remaining? And if I waited until next winter to do the AUS, I'd have to spend the year with this miserable incontinence.

Sorry to burden you with these non-medical considerations, but then that's part of my process.

Please do let me know how your consultation goes.

billmac22
Posts: 7
Joined: Dec 2012

I just got a reply from my RP surgeon's assistant. She says my sling is I-Stop.

http://www.clmedical.com/index.html

I'd be interested to hear what your doc says about it.

tpelle
Posts: 161
Joined: Aug 2003

bill: Thanks for your message. Both I-STOP and AdVance are in the same sling sub-category. The bulking agent was administered in the hospital out-patient section, under anesthesia. I had to have a driver to get me home. I can remember no pain either during the process or in the following days. There was a slight color of blood in the urine. Totally unsuccessful.

I'll find out what sling UCMed-Davis recommends and what they think of the I-STOP. The more I read, the more I think they will recommend the AUS 800 Artificial Sphincter, if anything. My leakage is not just from stress (cough, sneeze, lifting, etc), it's constant when I am standing or even to some extent sitting. I don't think that's a good pre-requisite for a successful sling outcome.

I hope our posts are of interest to others in our situation. tpelle

tpelle
Posts: 161
Joined: Aug 2003

Hi Bill: My consultation with Dr. Anthony Stone at U.C.Med-Davis (in Sacramento) went well. He obviously had read my ten-year file from my RPS surgeon as well as my notes which I attached to U.C.Med's questionaire. After a few preliminaries, he said the solution to my leakage would be either the AMS AdVance Sling or the AMS AUS800. However, first he needed to see the bladder and sphincter. The large monitor was immediately next to me while he was doing the cystoscopy -- observing the bladder and the sphincter. He showed me where the sphincter was deformed in that when it was closed, there was always a small opening at 6 o'clock. After he filled the bladder with fluid, that small opening is what was allowing fluid to leak at all times except when I was in bed, and sometimes when I was seated. He said the Sling would not work in my case and asked me if I was ready for the AUS800. I said yes and scheduled February 6 for him to do the procedure, his earliest appointment. I told him about U.C.Irvine using an I-STOP in your case. His response was that he does the AMS AdVance because of it's ten year history of favorable outcomes and that I-STOP was relatively new. Hope this helps. I was 71 at the time of my RPS. Today at the Med Center, my BP was 146/70 and pulse at 76. However, the averages of many readings at rest in the evening are 121/53 with a pulse average of 56. Dr. Stone had no comment regarding my 81 years of age. He did ask, however, why did I waited so long for a solution. tpelle

billmac22
Posts: 7
Joined: Dec 2012

Thanks for the update.

My surgeon did the urine study, pumping me full of saline, but he didn't do a cystoscopy. I wonder why?

I may have improved a slight bit since I last posted, but I'm not back to where I was before the sling surgery.

My next appointment in Dec. 27, so I'll see how I'm doing by then and see what he suggests.

Right now I have an aversion to the AUS surgery, but then I'm still in recovery from the sling installation. Maybe it will sound like a better idea after I've recovered and been normal (except for the leaking of course) for a while.

I appreciate the update. Good luck with the surgery, and keep us posted.

billmac22
Posts: 7
Joined: Dec 2012

I'm not sure if this will be of any particular value, but I might as well report on the results of the 6-week followup appointment after my sling surgery.

They had me perform a leak check to determine exactly how bad I was. They gave me a clean pad, started a clock, and then within the next hour I sat 15 minutes, walked 30 minutes, then got into and out of a chair ten times, ran in place for one minute, picked up simulated objects off of the floor 10 times, and maybe one other thing I'm forgetting. Then they weighed the pad. They had a range of weights for various degrees of leakage, with anything over 50 grams being severe leakage. My pad weighed 60 grams.

The surgeon suggested bulking injections as the next step, but we agreed to give it a couple of months to see if I will improve. Frankly, I don't have much faith in this guy. Besides making me worse with his sling surgery, he thinks that a kilogram equals 2000 grams and a pound equals 2.4 kilograms.

If I decide to take another step, I may ask the surgeon who did my RP for another referral.

tpelle
Posts: 161
Joined: Aug 2003

Thanks, Bill for the leak test results.  Sixty grams in an hour is quite a bit, even with the active testing procedure.  Were you at your normal hydration or did they fill you fluids immediately before the test?   For ten weeks this fall, I averaged leakage of 208.5 grams per day.  Some of that was activity but much of the time I was sitting at the computer or in my recliner, close to the toilet.  Also, it seems like the urologist should have checked the sphincter to see what shape it was in.  In my case, it was obvious that it wasn't closing tightly, and the fluid was leaking even when I was laying on my back.  All those years of my doing Kegels, the bulking injections, taking anti-depressant meds, etc. etc. were never going to work.  Wonder where your guy studied math?   tpelle

billmac22
Posts: 7
Joined: Dec 2012

Your 208 grams per day puts mine in perspective. The only time I've weighed mine was for the two days prior to this followup appointment. I've lost my notes, but I leaked a bit over 1000 grams one day and something over 700 grams the other day.

What is strange is that I seem to vary a lot. For the last two days my leakage has been much less- a level I might be tempted to live with. But I don't know why. Come to think of it, I've remembered to do my kegals about one time per day lately. Maybe I should quit altogether. 

bmorgan
Posts: 1
Joined: Jan 2013

Hi bbsc,

 

I became incontinent after a prostate cancer, with consequent extraction of my prostate. The first year I was using pads and special pants to fight against my urine leakage, but after a very bad year i ask to my doctor (dr. Kaplan) and he recommend me to underwent sling surgery. He decided to place me a readjustable sling MRS Remeex System. This sling, allows my doctor to readjust the urethral support whenever I need it, at any moment. This assures me that I will never have to re-enter to an operating room.

From my operation (Sept 2011) i have had two re-adjustments of the sling, and I am really incontinent and no retentionist.

I recommend you to ask about this option or to look for it on internet to understand better what I am talking about.

Good luck

bmorgan

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