Artificial Sphincter

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tjc
New Member


Date Joined Jun 2009
Total Posts : 2
   Posted 1/24/2010 4:18 PM (GMT -6)   
This is my first post here.  I am a little over 13 months since RP and the doctor and I are discussing an artificial sphincter implant.  I have control when I am sitting or laying down, but little to no control when standing, running, or any other form of exercise.  I would like to hear others experience or knowledge of the artificial sphincter process. 
Age: 55   Ht:6'0"  Wt: 210
Overall health:  Very Good
PSA:  Sept. 08   4.2
Biopsy 10/31/08   6 of 12 samples cancerous
Open RP: Dec. 15, 08
Cathiter complications and not out until March 9, 09
All PSAs undectable since surgery
Potency:  Virtually none; tried Cialis, Viagra with less than minuimal results.  Using pump 3 times per week.  Scheduled for Trimix on 01/22/10.
Incontinience:  continual leaking since cathiter removed.  Using penile clamp for control.  Considering implant for control in Aug. 2010..
 


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 347
   Posted 1/24/2010 4:38 PM (GMT -6)   
Can't answer your question. Others will be along with info. Just wanted to welcome you.
Sorry you have to be here, but we are all in this together.
Neal
age 45
psa 3.09
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side - 0/6
CT & Bone scan negative
Davinci Feb. 5th 2010


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/25/2010 10:31 AM (GMT -6)   
I have the aus... See my profile below for stats.  I've had it now for 18 months and am so very pleased.  Make sure your surgeon does enough of these to know what he's doing.  Someone who does 100 pr year or more or a little less would most likely do fine.
Gene214


PC diagnosed 12-06 @ age 63
Radical open removal 2-14-07, Gleason 3+3=6
Post-Surgery psa  -- .011
Removal of stricture 6-07, incontinence continues
01-15-08 psa -- .05
AUS, IPP implanted 07-16-08
AUS, IPP activated on 08-18-08.  They both work!
10-20-08 went back to surgeon for a follow-up.  Both devices work well.
10-20-08 psa -- .05
05-15-09 psa -- .07
 

Post Edited (Gene214) : 1/25/2010 8:41:09 AM (GMT-7)


jerseycity
Regular Member


Date Joined Nov 2008
Total Posts : 123
   Posted 1/25/2010 7:30 PM (GMT -6)   
have you considerd the sling or would that not help you level of incontinence? I am 16 months out with some leakage. Just did a hard workout and filled a pad. First time that happened, usually a half pad. What is your pad useage if you don't mind me asking. I am doing reaearch on sling at this time. AS seems like a pretty big step?
 3-17- 8 went to Bruce Springsteen concert , great time
3-18-8 routine exam
3-19 doctor called said psa was elevated
what's a psa?
referred to Uro, had several more blood tests.
PSA steady at 4.75
biopsy  June 08 , 12 cores, 4 on left confirmed , right clear
gleason 3 + 3 T1c
research time.
decieded on open RP, Head of Uro  is my Doctor
Surgery done 10-1-8 by Dr See at Frodoret Hospital in Milwaukee
Cathater out 10-13 no problems
Post op,  organ confined, gleason up to 4 + 3, all clear margins
T2c 20% volume, very good outcome I feel
Incontinent and ED.  Time will tell, was told all nerves  saved.
back to work 11-5-8.
 3,6,9 month psa <0.04 one year <0.04
still use 1 pad per day
 
Walked thru the darkness on the edge of town.


tjc
New Member


Date Joined Jun 2009
Total Posts : 2
   Posted 1/26/2010 3:54 PM (GMT -6)   
Thanks for the feedback Jersey City, 
 
When I talked with the doctor he felt like that with my age and activity level that the sling might not be affective.  While using the clamp I need a minimum of 3 pads per day and if I were to go with out the clamp I would need many more.  With my job I am on my feet and talking loudly to large groups of students for about 3-4 hours per day.  That is when the biggest problems occur along with when I am running.  Thanks for the feedback.  If you have any other thoughts please continue to offer.
Age: 55   Ht:6'0"  Wt: 210
Overall health:  Very Good
PSA:  Sept. 08   4.2
Biopsy 10/31/08   6 of 12 samples cancerous
Open RP: Dec. 15, 08
Cathiter complications and not out until March 9, 09
All PSAs undectable since surgery
Potency:  Virtually none; tried Cialis, Viagra with less than minuimal results.  Using pump 3 times per week.  Scheduled for Trimix on 01/22/10.
Incontinience:  continual leaking since cathiter removed.  Using penile clamp for control.  Considering implant for control in Aug. 2010..
 


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/26/2010 4:13 PM (GMT -6)   
jerseycity brough up a good point, and so did you tjc:
 
Jerseycity asked about pads & you responed... but you must consider what size pads you're talking about.  I now wear a "pad", even after AUS, but it's a tiny panti liner.  Sometimes I fill it up in an 18 hour day and somtimes it just put a spot of urine on it.  Before my radical, I went thgough 8-10 big-as-they-come pads.  As long as I was standing up or walking around, absolutely nothing stayed in my bladder. 
 
 tjc, from your original post, I gathered you were like me.  Just make sure you are really that bad off.  And if everything else fails, consider "going for it" (AUS).  A sling would never work ...if I understand your situation.
 
You also mentioned wearing a penis clamp.  I did that too and was able to stay more dry... a very good improvement, but as you know, clamps are not the best solution...l at least not for me.  One problem I had was occasionally my clamp would slip off and the whole load would come flooding out at once (I am uncircumcised).
 
AUS is a big step, but...
 
Gene214
 
 
PC diagnosed 12-06 @ age 63
Radical open removal 2-14-07, Gleason 3+3=6
Post-Surgery psa  -- .011
Removal of stricture 6-07, incontinence continues
01-15-08 psa -- .05
AUS, IPP implanted 07-16-08
AUS, IPP activated on 08-18-08.  They both work!
10-20-08 went back to surgeon for a follow-up.  Both devices work well.
10-20-08 psa -- .05
05-15-09 psa -- .07
 


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 1/26/2010 10:45 PM (GMT -6)   
    Jersey,  I also had the AUS installed by the same Doctor that Gene used.  You can read my links in my signature.  I was a heavy leaker.  I tried the AdVance Sling by AMS and had no luck with it.  The AUS is not as bad as it sounds  I also wear a light panty liner for drips and dribbles.  I do wear a regular Depends Guard for Men when I play golf.  But one last all day.  I agree with Gene.  Find a Doctor that does the AUS almost daily.  I drove from OKC to Dallas to get the right doctor for me.
    Good Luck
    KW 
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
     Dec. 2006 – Oct. 2008 Cystoscope, Two Collagen injections,Second Opinion   
    Consultation for Incontinance at OU Medical Center, Bio-Feedback       
    training, Chiropractic, Accupuncture , AdVance Male Sling, Two More Collagen 
    injections, AUS Installed and Activated (Dr. Morey at UT Southwestern Dallas TX)
    All to try to resolve incontinence (using 6-8 Depends Guards a day)

    To Date All PSA's 0.00.

   http://www.healingwell.com/community/default.aspx?f=35&m=721171

    http://www.healingwell.com/community/default.aspx?f=35&m=978691


tallguy
Regular Member


Date Joined Oct 2009
Total Posts : 419
   Posted 1/27/2010 7:40 PM (GMT -6)   
You are getting good advice from the others but I will add a couple more things I learned here. I am a constant leaker when standing or moving around. If I am setting or laying down I can get to the can in time...usually. If you have not done ask your doctor about FUDS/urodynamics testing. This will determine if you are a candidate for a sling or not. Also, if you have not done it go to the topic AdVance Male sling and read the posts. You will see that if you do a sling and it does not work you can still have the AUS. If you do the AUS first the sling is not an option. Also, I have read that the the AUS may need to be replaced after 8-10 years so consider that as well given your age. Seems like those with the AUS like KW are very satisfied with the sling and you are pretty well guaranteed that this will fix the leakage.
Based on the FUDS/urodynamics testing and my pad weights of about 200 grams my doctor feels I am a good candidate for a fix with a sling. I will have mine done at NYU next Wednesday and will post the results on this forum as I go throught the process.
Tallman
64  year old male in excellent physical condition.
No serious illness of any kind.
PSA jumped from 3 to 8 in one year between annual physicals.
Biopsy/pathology confirmed postate cancer.
pt2b NO Mx with a Gleason score 3+3=6.
DaVinci prostatectomy, Robotic surgery July 23, 2008.
Tumor type: Acinar
size 5.5 cm x 5.7 cm weight: 77 gm.
Largest tumor nodule: 1.3 cm
All surgical margins were negative.
Seminal vesicles uninvolved by tumor.
Urinary incontinence incurred immediately followin surgery. Dry at nights but no control during day. Tried drugs imipremine and detrol but no help and caused side effects so stopped them.
Unable to obtail erection from beginning. Viagra and Cialis were used in low dose but caused headache so discontinued. Using pump for erection effectively with rubber clamp.Very loving relationship with wife and we are both fine with this situation as it is.
Underwent physical therapy and kegal exercises with no results for incontinence.
Uideo fluoroscopic urodynamics and cystourethroscopy testing in Oct. 2009. Resulted in recommendation for surgery to insert InVance Male Sling System for incontinence cure. Alternative is new sling called Virtue by Coloplast. Planning this surgery for January 2010.


Salty_clark
Regular Member


Date Joined Apr 2008
Total Posts : 95
   Posted 1/28/2010 9:21 AM (GMT -6)   
For what its worth I thoroughly support the AUS for heavy leakers.  I had the same surgeon as Gene and KW (Dr Morey of Dallas.)  It has been almost a year now since my activation and I am very satisfied.  I have, however, found that I feel more comfortable wearing a ladies panti-liner tucked in my shorts to catch the drips and dribbles of a coughing or sneezing episode.  The panti-liner is not a necessity...but lets me go about my normal day activities without thinking about any continence problem.  I change once per day at shower time and this allows me to feel completely normal in anything that I wish to do during the following 24 hours.  I guess what I am trying to say is that now I feel normal after the harrowing experience of PCa and subsequent after-affects.  I think the deciding factor as to selection of AUS or sling is merely the amount of leakage.  If you consider yourself a severe or heavy leaker then get the AUS...and I was a severe leaker so it wasn't a hard decision for me.
 
 
Good Luck to you
 
Salty

Age 75 at DX 76 on 9 May 08
DRE positive with nodule 15 Jan 08
PSA 3.8 18 Jan 08
Biopsy 11 Mar 08 Gleason 8 (4+4) on the right 3 out of 12 positive <5%. Gleason 7 (4+3) on the left 1 out of 11 positive <5%.
Bone scan and CT scan Negative 12 Mar 08
Robot Assisted da Vinci prostectomy with Dr Fagin in Austin scheduled for 30 April 08.
- - - - - - - -
da Vinci successfully completed by Dr Fagin as scheduled.
Path Report:
Gleason downgraded to 3+4=7
Tumors confined to the prostate.
Bilateral tumor on right side 5 of 10 levels and on left side tumor present in 9 of 10 levels.
Margins Negative.
Extraprostatic Extension Negative
Seminal Vesicle Invasion Negative
Stage pT2c
As far as it goes between you, me and the fence post I am cured. 
06-24-08 <0.1 Undetectable.
09-23-08 <0.1 Undetectable.
01-10-09 <0.01 Undetectable. 
04-17-09 <0.1 Undetectable.
AUS/IPP installed by Dr Morey 1/21/09 Activation 03/09/09 successfully completed by Dr Morey...All Systems GO!  99.9% continent.


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/28/2010 2:07 PM (GMT -6)   
Salty,
 
Didn't you report to me that your AUS was not working?  Maybe it was somone else, but I thought it was you?  If it was, I'm glad it's working for you.  If I've got the wrong, guy... well, pardon me.
 
Gene214
 


PC diagnosed 12-06 @ age 63
Radical open removal 2-14-07, Gleason 3+3=6
Post-Surgery psa  -- .011
Removal of stricture 6-07, incontinence continues
01-15-08 psa -- .05
AUS, IPP implanted 07-16-08
AUS, IPP activated on 08-18-08.  They both work!
10-20-08 went back to surgeon for a follow-up.  Both devices work well.
10-20-08 psa -- .05
05-15-09 psa -- .07
 


Salty_clark
Regular Member


Date Joined Apr 2008
Total Posts : 95
   Posted 1/28/2010 7:52 PM (GMT -6)   
Gene...Don't know where you got the idea that my AUS wasn't working.  Like everyone else that gets an AUS, there is the period of time between the surgery and the activation when one experiences the same heavy leakage.  But, as usual, once the activation takes place the flow has been controlled by the AUS button.  "Ain't it wonderful being dry after the monsoon following the RP."
 
Best Wishes
 
Salty

Age 75 at DX 76 on 9 May 08
DRE positive with nodule 15 Jan 08
PSA 3.8 18 Jan 08
Biopsy 11 Mar 08 Gleason 8 (4+4) on the right 3 out of 12 positive <5%. Gleason 7 (4+3) on the left 1 out of 11 positive <5%.
Bone scan and CT scan Negative 12 Mar 08
Robot Assisted da Vinci prostectomy with Dr Fagin in Austin scheduled for 30 April 08.
- - - - - - - -
da Vinci successfully completed by Dr Fagin as scheduled.
Path Report:
Gleason downgraded to 3+4=7
Tumors confined to the prostate.
Bilateral tumor on right side 5 of 10 levels and on left side tumor present in 9 of 10 levels.
Margins Negative.
Extraprostatic Extension Negative
Seminal Vesicle Invasion Negative
Stage pT2c
As far as it goes between you, me and the fence post I am cured. 
06-24-08 <0.1 Undetectable.
09-23-08 <0.1 Undetectable.
01-10-09 <0.01 Undetectable. 
04-17-09 <0.1 Undetectable.
AUS/IPP installed by Dr Morey 1/21/09 Activation 03/09/09 successfully completed by Dr Morey...All Systems GO!  99.9% continent.
12-09 0.01 Undetectable.


rapids
New Member


Date Joined Oct 2006
Total Posts : 16
   Posted 2/6/2010 6:57 PM (GMT -6)   
Dear TJC
 
I'm sure you know InVance, AUS and AdVance are options. But have you heard of "Virtue" by Coloplast? Check it out before you go with Advance. It's similar to Advance except that it works by elevation (Advance) as well as slight compression, with 2 extra "arms."
 
I didn't want all that "hardware" with AUS and decided on Virtue. It's relatively new, but I opted for it and am completely continent after almost 4 years of about 3 pads a day. 
 
rapids

tallguy
Regular Member


Date Joined Oct 2009
Total Posts : 419
   Posted 2/7/2010 9:37 AM (GMT -6)   
TJC,

Your condition sounds similar to mine before last week. I had the Coloplast Virtue Sling surgery last Wednesday. I am now pretty much totally dry and have much the same experience as rapids. We used the same doctor. If you want to read more about my experience go to the thread, tallmans journey to coloplast male sling.
Based on what I have learned the AdVance may not be enough for you. AUS would be if you can accept that surgery and how it works. Virtue could be an option but you would need to use a doctor with experience and using proper technique.
64  year old male in excellent physical condition.
PSA jumped  3 to 8 in one year
pt2b NO Mx with a Gleason score 3+3=6.
DaVinci RP,  7/23/08. Tumor type: Acinar
size 5.5 cm x 5.7 cm weight: 77 gm.
Largest tumor nodule: 1.3 cm. All margins negative.
Incontinence & ED. Dry nights , no control during day.
Imipremine and detrol, Phy ther. and kegals no help.
FUDS and cystourethroscopy testing 10/09.
24 hr pad wt. 219gm. AUA sympton index 13/35=moderate
Incontinence symp. index severeity sore=22
Rec. for sling surgery. Dr. does mostly InVance.
Researched and decided on either AdVance or Virtue.
Virtue sling surgery 2/3/10 NYU med center by Dr. Victor Nitti
 

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