Incontinence fix – ATOMS, AUS or AdVance?

Progress report - the cushion of my ATOMS sling now has 15ml of fill fluid in it, and in my particular case according to my urologist, I can only get it pumped up to 22ml. In effect, two more 3ml top-ups.

Installation with 9ml saw my daily leakage drop from approx 200ml per day to 30-35ml per day once the swelling went down. My first 3ml top-up only saw a slight improvement to 30ml per day. My latest top-up, now that I've had the time to monitor myself, has seen a significant improvement. I'm still leaking, but my average is now around 20ml per day. This means I can get away with wearing a light shield or liner which lasts for the entire 24 hours of a day. The biggest negative impact on leakage remains physical activity, not caffeine or alcohol.

It looks like the sling won't be a complete success for me. I am thinking that I will only get one more top-up for now, probably in early February, leaving myself some room if things deteriorate in the future. My short-term aim is to be completely dry overnight (most nights in bed I'm still losing 1 or 2ml, but sometimes I have no loss) and to be honest, I'm so used to having something in my undies now, if I still have to wear a shield or liner through the day and be confident that it will do the job, and not have to wear anything overnight, then that's good enough for me, especially considering my pre-surgery leakage.

Hi there @Itzagift, thanks for chiming in!

You've raised some great points and now that I'm well past the recovery stage, I'm able to provide some more info based on my own observations. Hopefully others reading this will benefit too.

I also like riding a bike. The information pamphlet given to me before the surgery said no bike riding after the sling is installed! What wasn't made clear was whether this meant just during the recovery period, or forever. I asked this question to my urologist and the best he could suggest was to use a split seat, like you do. I ended up not doing so; although I didn't get back on my bike until early December, about a week before my second top-up, it was on my original seat and wearing my padded bike shorts. It was only a gentle, 15min ride in a park, and I seemed to suffer no serious issues with it. I weighed my pad before and after the ride and only lost 3ml, but I recall feeling a bit of a squirt as I got off the bike, so that's probably when most of the leakage occurred. Since then, due to a variety of circumstances, I've only been on the bike once. That was last week, a 45-min ride on some less-than-smooth gravel cross country paths and I was putting in a fair effort. I only lost 5ml and had no pain or other issues. I've come to the conclusion that a split seat or similar is not necessary for me, but I will always wear my bike shorts with the inbuilt padding. The "No bike riding" advice must have pertained just to the recovery period.

I can obviously feel where my filling port is and also feel where the tube to the cushion runs, before it disappears into my body. I can visualize where the cushion is and I'm confident that riding a bike will not damage it. I do have some hard scar tissue on my perineum, but it gives me no trouble.

It's interesting with the issue of standing up or sitting down to void. Pre-surgery I did either, but sitting down was actually less messy, particularly at the start. And, if already seated, it was natural. But now, it is almost impossible to start a stream while seated! I think this is because with my body in that position, it's like the sling cushion is being further compressed. This might explain why I wasn't aware of any leakage during my first bike ride, but I was very aware of leakage when I stood up.

My next (third) top-up has been booked for February 6th.

I haven't exactly had an easy time with the whole ordeal lately. A major reason that my urologist wanted this most recent top-up to be my last, despite the cushion not quite reaching its maximum capacity, was the ever present but small chance of infection at the entry site. Around 1 - 2% apparently, which is not insignificant. The less top-ups the better, etc. In an extreme case, infection that makes its way from the filling port to the sling would necessitate removal of the sling, so back to square one.

The day after the top-up I noticed that the skin on my scrotum was itchy for a day. This didn't happen after the other times. I then started to experience some stinging while voiding and also developed some pain at the tip. Also some redness and tenderness on my ol' fellas skin at times. This coincided with the start of a short interstate trip, and I was pretty uncomfortable on the plane. I began taking an alkalinizer and the symptoms slowly alleviated. I emailed my urologist when we got back home on Feb 14th and he rang back within half an hour!

Turns out that the types of symptoms that he was concerned about only pertained to what would indicate infection at the top-up entry site; the skin on my scrotum. After assuring him that I had some itchiness for one day only, he assured me that the other symptoms that I described weren't related. This was my thinking too - how could infection in a device external to my urethra show up as symptoms inside of it? His explanation was that all the nerve endings around there are interrelated, and that too much retention in the bladder can actually produce pain in other parts of the system. I'm not sure about that, but at his suggestion I had another flow test and ultrasound today and passed with flying colors. So, the symptoms have gone (mostly) and there was no real reason for them. BUT...

I have had a sore lower back over the past few weeks which was already present at my last top-up. I couldn't quite localize where the pain was coming from. It seemed to wander around a bit, so my question was whether the attachment straps of the sling around my ischium bones could be causing irritation or pain. No was the answer. My back progressively got worse with referred pain showing up in my buttock, hip and thigh, then numbness around my knee and into my lower leg. Classic signs of a pinched nerve. It's been a horrible time, I'll tell you. Since then, I've been to see a totally useless doctor (although he did prescribe me some nice drugs) and a very useful physio, and I'm well on the way to recovery now.

I will talk to my urologist again tomorrow after he receives the results of today's flow test. It will be interesting to see if the symptoms that I described earlier could also be attributed to the pinched nerve as well.