New procedure for Incontinence

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drmartin
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted 8/31/2009 7:11 PM (GMT -6)   
Okay.....I have been lurking and reading about the various incontinence procedures available.
In Southern California there are very few doctors that preform the Advance procedure, which is what I had resolved myself too. I have been searching for almost a year with no luck in finding a doctor that 1. takes my insurance and 2. Preforms the procedure.

A few months ago I came upon a surgeon in Az. by sheer luck and a few reference trails. Well come to find out this doctor no longer practices in Az. Of course :(...... so my trail ended sadly.

A few weeks after I gave up, I received a phone call from one of his nurse assistants that had left the office he was at. She remembered I had left a message and gave them my story and she had copied my phone number. She said the doctor had relocated to Stanford Medical in Palo Alto Calif. and is doing a clinical trial for a new device that is similar to the Advance sling and implanted in similar Fashion and if I was interested she could give me his number to get in contact with his research assistant with whom she talked to already. And of course I said Hell yes!...lol

Well, I have been in contact with them for over a month now. and I'm going in on Sept. 15th for my pre-op testing and interviews. The nurse said after my phone interview, it sounded as if I would make a perfect candidate and if nothing major is wrong with me I will have the procedure on Sept. 22nd.
My only concern is that flight coming home...its only 1 hr and 15 min. but its sitting the whole time. So my question to any members here is this. After your invance or advance Surgery how was your travel situation and did you have to travel far for your procedure? I know the incision is in the perineal area...How much pain after the anesthesia wore off? I will be in a hotel for a full day of recovery after the procedure.

For those that are curious....the Procedure is called The Virtue Male Sling.by Coloplast A/S, it is a new device invented in Denmark. Here are the links for the Study and the Device

Virtue Male Sling;

http://www.coloplast.com/about/news/Pages/VirtueincontinenceslinglaunchedinUS.aspx

Clinical trial info;

http://clinicaltrials.gov/ct2/show/study/NCT00856778

Thanks for reading and responding,

David M.
Age: 54

11/10/2006

PSA 10.2 - Discovered during Annual Physical with Family Doctor

Referred to Urologist Surgeon specialist

Free and total PSA - 10.9

Biopsy ( sent to John Hopkins pathology) - 2 of 16 positive on left and right apex of prostate

Left - GS 3+3=6, Right - GS 3+3=6

Davinci assisted laparoscopy radical prostatectomy on Apr. 17, 2007 -Complications due to extreme unusual size of prostate. Normal Prostate = 20 to 31 grams. Mine = 120 grams (not enlarged, but genetic growth large)

Nerves on right side spared.

All Lab's clear. No Cancer outside prostate

Cystogram Apr. 24 2007- Slight leakage at anastomosi negligible.

Catheter in for 1 week Removed Apr. 24, 2007

May 30th, First post-op PSA results...Non-Detectable!
Aug 18th, Second post-op PSA results...Non-Detectable!
Nov 8th, Third post-op PSA results...Non-Detectable!
April 17th, One year anniversary .010 Detected changed back to 3 month monitoring 


AML
New Member


Date Joined Aug 2009
Total Posts : 4
   Posted 8/31/2009 7:52 PM (GMT -6)   

Good luck with the new procedure.

I am not sure about flying, but I found that using a Donut (inflatable rubber ring cushion) to be very helpful.  In fact, my wife just bought  me one today, and for the first time after my surgery (which was 2 weeks ago), I could sit at my desk for a few hours today.  Any drugstore should have these.

AML

 


Age: 47
PSA (2007)=1.8
PSA (2009 pre-biopsy) = 9.4 and 8.4
Biopsy: May 19, 2009 - Diagnosis: end of May 2009
One (1) out of twelve (12) cores was positive.
Gleason Score = 3+3, Stage: T1C
Robotic prostatectomy using Da Vinci: 8/18/09
Removed Catheter: 08/26/09
 


drmartin
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted 8/31/2009 8:25 PM (GMT -6)   
Good advise, ty AML
Age: 54

11/10/2006

PSA 10.2 - Discovered during Annual Physical with Family Doctor

Referred to Urologist Surgeon specialist

Free and total PSA - 10.9

Biopsy ( sent to John Hopkins pathology) - 2 of 16 positive on left and right apex of prostate

Left - GS 3+3=6, Right - GS 3+3=6

Davinci assisted laparoscopy radical prostatectomy on Apr. 17, 2007 -Complications due to extreme unusual size of prostate. Normal Prostate = 20 to 31 grams. Mine = 120 grams (not enlarged, but genetic growth large)

Nerves on right side spared.

All Lab's clear. No Cancer outside prostate

Cystogram Apr. 24 2007- Slight leakage at anastomosi negligible.

Catheter in for 1 week Removed Apr. 24, 2007

May 30th, First post-op PSA results...Non-Detectable!
Aug 18th, Second post-op PSA results...Non-Detectable!
Nov 8th, Third post-op PSA results...Non-Detectable!
April 17th, One year anniversary .010 Detected changed back to 3 month monitoring 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 9/1/2009 7:56 AM (GMT -6)   
For the long term sufferer, the use of a foam ring, rather than rubber or vinyl works better. I tried the rubber and quickly switched to the foam. Made a world of difference to me. Found in most large drug stores, especially medical supply sections of them.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.05ml 2X week continues
PSA's: .04 each test since surgery


brodie12
New Member


Date Joined Dec 2007
Total Posts : 18
   Posted 9/1/2009 8:05 PM (GMT -6)   
David It sounds very, very encouraging , keep us informed of your progress.. Best of luck Brodie

brodie12
New Member


Date Joined Dec 2007
Total Posts : 18
   Posted 9/17/2009 8:39 PM (GMT -6)   
wondering how it went on the 15th with the pre-op for the virtue sling Brodie

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 9/18/2009 9:59 PM (GMT -6)   
I'll be watching your results very closely... very closely indeed. This subject in near and dear to me.
I'm curious, how much of a leaker are you? 4 Pads per day? More? At what point do they recommend this procedure. Thanks, Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
----------------------------------------------
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
----------------------------------------------
Post Surgery Status:
Potency - 9/17 2 months, Still no activity
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day. At this rate I'll be fine in 2011.
Post Surgery PSA - 9/3 6 weeks - 0.05


drmartin
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted Yesterday 9:42 PM (GMT -6)   
Hi all, and ty for the replies.

I did go in on the 15th and had a Urodynamic test done. The results showed that I had a perfect functioning bladder, But my sphincter was almost non-functional. The Dr was really surprised at that, considering that I am only going thru 3 full pads a day. He said he was amazed that I had any control at all and that all the Kegals in the world would not help me.
He said his theory for this is the size of my prostate. My Prostate acted as the sphincter making the actual sphincter very weak (Atrophy)

He is predicting a success rate of 80% to have a reduction to one pad or less. Keeping my fingers crossed.

See ya'll when I get back and I will post an update. Surgery is scheduled for Tuesday the 22nd in the morning.

Thanks for your concern

David

PS...Worried Guy...this procedure is recommended for up to 4 pads a day. Also you should consider waiting a year before thinking of surgery.
Age: 54

11/10/2006

PSA 10.2 - Discovered during Annual Physical with Family Doctor

Referred to Urologist Surgeon specialist

Free and total PSA - 10.9

Biopsy ( sent to John Hopkins pathology) - 2 of 16 positive on left and right apex of prostate

Left - GS 3+3=6, Right - GS 3+3=6

Davinci assisted laparoscopy radical prostatectomy on Apr. 17, 2007 -Complications due to extreme unusual size of prostate. Normal Prostate = 20 to 31 grams. Mine = 120 grams (not enlarged, but genetic growth large)

Nerves on right side spared.

All Lab's clear. No Cancer outside prostate

Cystogram Apr. 24 2007- Slight leakage at anastomosi negligible.

Catheter in for 1 week Removed Apr. 24, 2007

May 30th, First post-op PSA results...Non-Detectable!
Aug 18th, Second post-op PSA results...Non-Detectable!
Nov 8th, Third post-op PSA results...Non-Detectable!
April 17th, One year anniversary .010 Detected changed back to 3 month monitoring 

Post Edited (drmartin) : 9/19/2009 9:14:18 PM (GMT-6)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted Today 8:36 AM (GMT -6)   
Drmartin...
I see that you are 17 months after surgery. That's along time. Clearly you're a better man than me!
OK, I'll be patient and do a little more Watchful Waiting. Please let us know what happens.
Good luck Tuesday! May all your plumbing work to specifications.
Jeff

AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 9/24/2009 4:15 AM (GMT -6)   
Interesting... I went to see a new urologist/specialist yesterday and he recommended one of these Virtue brand slings (which seem to be a better design than the AdVance brand sling). I'm scheduled to be scoped on 10/15 in prep for this procedure - I was scoped last May and everything was fine then, so I expect it'll be fine again and I'll be a candidate for this procedure. I'm not looking forward to more surgery, but... being dry (or mostly dry) would be worth it.

Hope your procedure went OK!
cheers & beers,
Chris


Diagnosed on 9.23.08, age 47
Gleason 6, T1a
da Vinci LRP performed 1.22.09 at Moffitt Cancer Center by Dr. Pow-Sang
Catheter out on 2.4.09!!!!
Pathology: Gleason 7 (3+4), T2c. Tumor 15%, fully contained, margins clear, lymph clear.
5.13.2009: PSA of zero!
5.20.2009: Cystoscopy all good.


GeorgieBoy
New Member


Date Joined Sep 2009
Total Posts : 2
   Posted 9/24/2009 8:00 PM (GMT -6)   
Hello there - I have been doing quite a bit of research into the Virtue Sling from Coloplast. I found this site by doing a google.com search...Anyway, I wanted to share a couple things regarding the Virtue Sling with you that you should take into consideration before trying it. I swear by the AdVance Sling!

1) Clinical Trial - if you are part of a clinical trial - you are being used as a guineau pig. The Virtue Sling has NO DATA behind it. AdVance has been implanted in over 16,000 patients as has quite a bit of data behind it. Some of the most well-respected doctors in the world implant it, including Dr. George Webster at Duke University and Kurt McKammon in Virginia, among others.

2) The Virtue Sling is actually a lot different from the AdVance Sling. The AdVance Sling is completely NON-OBSTRUCTIVE. Obstructing via compression, the Virtue Sling can potentially damage important structures in the male pelvis, especially the nerves, including the posterior scrotal nerve, the superficial and deep scrotal nerves, and the pudendals, to name a few. The AdVance effects a proximal relocation of the urethral bulb...you don't want to compress the structures there.

3) The Virtue Sling is placed over the bulbospongiosum muscle. This is likely to cause a high level of pain post-op, versus the AdVance, which is not placed over the bulbospongiosum.

4) The follow-up data and outcomes with the AdVance are excellent - over 36 months of follow-up data, with success rates of around 85% for the average patient in "good pelvic condition".

5) Lastly, the mesh used in the Virtue Sling is very closely related to the mesh from a product called "ObTape" by Mentor - who sold their Urology business to Coloplast. Google "ObTape" to see what I am talking about. The mesh isn't exactly the same, but has very similar qualities.

Good luck!

GeorgieBoy
New Member


Date Joined Sep 2009
Total Posts : 2
   Posted 9/24/2009 8:06 PM (GMT -6)   
I forgot the most important thing: If you have a Virtue Sling implanted - there is a chance due to the fact that it goes over the bulbospongiosum muscle that you CANNOT HAVE AN ARTIFICIAL URINARY SPHINCTER implanted if the sling fails...! Not good as the AUS is the gold standard for male incontinence and the "fall-back, fail-safe" procedure...

drmartin
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted 9/26/2009 8:27 PM (GMT -6)   
Hi all, I'm back ;)

The procedure went as planned and I'm still a bit sore after. Mainly my hips feel disjointed and out of place on the right side apparently I was in stirrups and almost upside down with legs fully opened knees out.. I could not walk the first day but i did manage to sit up and dangle my feet over the side of the bed. on the second day I was able to walk down the hall with aide of crutches. I left the hospital the second day with the help of my grandson. After I picked up my meds (Vicodin, an anit-biotic and a stool softener (wheeeew thank god for that one ...lol)) I was in the hotel for one more day and there was great improvement in my mobilty so I got rid of the crutches and walked a couple of hallways upstairs and downstairs, with the use of the elevator of course ;). I made it thru the airports with the use of a wheelchair and was able to drive myself home.

Now for the important stuff. When the Catheter was removed I was amazed that no urine was released. But when I stood to walk I did leak profusely. I immediately clamp myself with my fingers and made it to the bathroom. Now this is when disappointment set in. Each time I stood I had the urge to go and as a reflex I clutched myself to prevent leakage.

The first night at home I fell asleep in my recliner the most comfortable for sitting in the house. When I woke up I had the urge to go and went directly to the bathroom and stood in front of the toilet and I just noticed.....I didn't clutch myself to get there and nothing was coming out when i exposed myself...then I added a little pressure and ...TADAAAA! a stream appeared :)

now since that event I haven't clutched myself at all and was dry all the way to the bathroom. yesterday I test and walked a couple of laps around the living room and family room before going to the the restroom and still dry. Woohooo!

I have only used 3 pads since I have been home and the were change just because I needed to shower...they were nowhere near full. I still have minor dribbles when i cough, laugh and sneeze.

well thats all for now. I will keep you all apprised of anything else significant occurs.
All questions are welcome.

Now as For GeorgieBoy....

You know that if it weren't for "Guinea Pigs" and clinical trials you could not be a proponent of the adVance Male sling Procedure. All procedures start somewhere.

The Doctor I choose to go with was the Co-inventor of this procedure and had done over 200 invance and ad Vance Procedures. He is a big supporter of the ad Vance procedure as well but felt that my leakage rate was not appropriate for the ad Vance but did suggest the AUS. I asked specifically if this procedure didn't work would I still be able to have the AUS install and he assured me that it could. He did it for another patient that had a leakage of 8 pads per day and the Virtue didn't help at all.

keeping my fingers crossed now. Thanks to all of you following this leg of my journey. Oh and my last PSA on 9/4/09 was less than .01 :)
Age: 54

11/10/2006

PSA 10.2 - Discovered during Annual Physical with Family Doctor

Referred to Urologist Surgeon specialist

Free and total PSA - 10.9

Biopsy ( sent to John Hopkins pathology) - 2 of 16 positive on left and right apex of prostate

Left - GS 3+3=6, Right - GS 3+3=6

Davinci assisted laparoscopy radical prostatectomy on Apr. 17, 2007 -Complications due to extreme unusual size of prostate. Normal Prostate = 20 to 31 grams. Mine = 120 grams (not enlarged, but genetic growth large)

Nerves on right side spared.

All Lab's clear. No Cancer outside prostate

Cystogram Apr. 24 2007- Slight leakage at anastomosi negligible.

Catheter in for 1 week Removed Apr. 24, 2007

May 30th, First post-op PSA results...Non-Detectable!
Aug 18th, Second post-op PSA results...Non-Detectable!
Nov 8th, Third post-op PSA results...Non-Detectable!
April 17th, One year anniversary .010 Detected changed back to 3 month monitoring 


drmartin
Regular Member


Date Joined May 2007
Total Posts : 42
   Posted 10/17/2009 11:05 PM (GMT -6)   
Update:

Tuesday will be my One month anniversary of the "Male Virtue Sling Implant". So I thought I would update my progress.

I am down to one pad for safety sake. Down from 3-4 full pads per day. I finally can sleep Al Fresco!...woohooo first time in almost 3 yrs.
I can now control myself enough to get to a restroom when the urge calls. I sill have very minor leakage after urinating and during more stressful activities but not enough to fill a pad.

So at this point I am considering myself a success story. I still have surgical soreness in the perineum, but that is slowly decreasing. I go back to Stanford on Nov. 4th for my post op follow up. I will post my results after.

Any questions please ask.

David M.
Age: 54

11/10/2006

PSA 10.2 - Discovered during Annual Physical with Family Doctor

Referred to Urologist Surgeon specialist

Free and total PSA - 10.9

Biopsy ( sent to John Hopkins pathology) - 2 of 16 positive on left and right apex of prostate

Left - GS 3+3=6, Right - GS 3+3=6

Davinci assisted laparoscopy radical prostatectomy on Apr. 17, 2007 -Complications due to extreme unusual size of prostate. Normal Prostate = 20 to 31 grams. Mine = 120 grams (not enlarged, but genetic growth large)

Nerves on right side spared.

All Lab's clear. No Cancer outside prostate

Cystogram Apr. 24 2007- Slight leakage at anastomosi negligible.

Catheter in for 1 week Removed Apr. 24, 2007

May 30th, First post-op PSA results...Non-Detectable!
Aug 18th, Second post-op PSA results...Non-Detectable!
Nov 8th, Third post-op PSA results...Non-Detectable!
April 17th, One year anniversary .010 Detected changed back to 3 month monitoring
Sept 17 2009 PSA < .010 non-detectable

Sept 22 2009:

Surgical implant of the Male Virtue Sling at Stanford Medical Urology center.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 10/18/2009 5:21 AM (GMT -6)   
Congratulations. Thank you for "Taking one for the team" and being one of the first. For any procedure some hero needs to be first. Hat's off to you.
May you leak less each day.
Jeff

male_sling_problems
Regular Member


Date Joined Nov 2009
Total Posts : 134
   Posted 11/1/2009 10:41 PM (GMT -6)   
I read Georgie Boy's post with great interest.
 
I was implanted with a Coloplast Virtue male sling approximately 3 1/2 months ago. It has been a terrible experience for me. My incontinence worsened dramatically and the pain continues to be intollerable. The mesh that is wrapped around the rami (bones in my lower pelvis) feel like I am sitting on a broomstick. This is becomming more painful each day. My scrotum skin continues to burn and sting to the touch. My entire bottom side throbs continually. My urologist could only offer nerve medicine, nerve blocks or very strong narcotic pain killers. I do not wish to live doped up on pain medication. 
 
 I had appointments at The Cleveland Clinic last week and they will be surgically removing the Coloplast implant ASAP. They warned me that the pain and stinging sensations may continue for one year, following surgery, due to nerve iritation and damage from this device. I will be evaluated for AMS's AdVance sling when the Coloplast sling is being removed. If my condition permits, an AdVance sling will be implanted at that time. The AdVance sling is much less invasive than the Coloplast sling.
 
I do not anticipate any problems with the AdVance sling since only two mesh supports are routed upward from the bladder and it does not requite the tightly tensioned rigid mesh arms that are wrapped around my lower pelvic bones nor does it require the hard feeling mesh platform that is causing intollerable nerve irritation inside my sctotum.
 
I will soon be in the unenviable position of comparing both implants from personal experience.

And if GeorgieBoy reads this posting, please email me at: bigxbadxjohn2@yahoo.com You were 100% on track with your warning!

Post Edited (male_sling_problems) : 11/2/2009 6:06:55 PM (GMT-7)


male_sling_problems
Regular Member


Date Joined Nov 2009
Total Posts : 134
   Posted 11/2/2009 8:03 PM (GMT -6)   
GeorgieBoy      Please email me at: bigxbadxjohn2@yahoo.com Your information was extremely useful and timely for me. I was recently implanted with the very device you were warning others about. It has been a total disaster! I am hoping to get some more information from you as I plan to have my Coloplast Virtue male sling surgically removed ASAP.

Thanking you in advance, John
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