Frustrated with AMS Male Sling surgery

 

A little history (I like bullet points)

- RPP in January 2009

- Incontinent and Impotent from the get-go

- For incontinence I tried:

  - Waiting

  - Using a condom catheter (UroDry... pretty good stuff)

  - Kegels

  - Physical Therapy

  - After all that I went from 5 to 6 pads right after surgery to 2 to 3 pads a year later

- For ED I tried:

  - All the pills: Viagra, Levitra, Cialis: I couldn't take the side effects and I didn't get a full erection

  - VED pumps: As soon as the pump was removed, so did the erection

  - bi-mix and tri-mix injections:  Just made Mr. Happy sore, no more effect than the pills

 

So, my Urologist recommended that I have surgery to "install" two devices:

#1 the AMS Male Sling

#2 the AMS 700 LGX penile implant

both during the same surgery session.

 

One day post surgery, I was not able to urinate on my own.  I was discharged from the hospital with a foley cahteter.  Five days post surgery, I had the foley removed, but I could not void on my own.  Later that evening, I had to go the ER to get another cath put in.

 

Another week passes, I have the foley removed, but I stay at the hospital to see if I can void.  I cannot. So my Uro gave me some intermittent catheters so that I can completely drain my bladder 3x a day at home.

 

I am now 4 weeks post surgery and here's my situation:

- I have to "go" about every hour

- When I do, I void about 150 ml

- When I cath, right after I void, 3x a day, I get anywhere from 150 ml to 250 ml

- When I have the urge to go, it's immediate.  If I'm not near a bathroom, I still leak anywhere from a couple drops to filling my diaper (I'm using the belted shields)

 

That's the main problem.  I'm starting to get the "hang" of the implant.  I can pump myself up to a useful firmness, although I have not been released to attempt intercourse yet.  However, the pump in my scrotum (I call it my 3rd ball) is irritating the inside of my scrotum.  However, I'm sure that will get better as time progresses.

 

So, after all that, am I to expect that the male sling isn't doing the job it's designed to do?  Should I approach my urologist about an artifical sphincter?

 

I'm just frustrated that I'm back to using the diapers PLUS I have to cath 3 times a day.

 

Anybody have any insight?

 

---

Diagnosed: November 2008: - PSA 4.5 - 3 Cores out of 12 Positive - Gleason 6 (3 + 3)

Surgery: Nerve Sparing RRP on January 6, 2009, Age 53- one night in the hospital

Catheter: Removed on January 20, 2009.

Side Effects:    Incontenance - leaking like a sieve

(as of 1/27/09)  Impotence - half-staff with Levitra

April 1, 2010:

AMS Male Sling

AMS 700 LGX Penile Implant

 

 

 

My situation was very similar to yours post RP surgery. I have not tried anything for ED other than the big three drugs which gave no help and the pump that works only if I rubber band it off. Just put the ED thing on hold until I get the incontinence solved which will be an AUS mostly likely this July. At age 66 the ED thing is not a problem for me and my spouse. It looks like the AUS where you will need to go but it might be a bit early to do that until you get some more of the problem areas addressed first. Based on your results and problems you might want to get a second opinion if your Uro is the same one that did the sling. Surgeon skill (plus a good dose of luck) is huge with slings based on what I learned on this forum.

---

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.

Imipramin 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 score=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

Appeared to help but gradually returned to pre surgery condition.

Back to 3-4 pads/day, stopped drugs, plan for AUS next winter.

Latest PSA 4/1/10negative.

 

 

I went back to the urology clinic (did I mention that I'm being seen at Evans Army Community Hospital, Fort Carson, CO since I'm retired military) and did get a second opinion and also, during the course of the visit saw the original Urologist passing in the hall.

 

Here's the two opinions.

 

My original Uro is actively following up on this.  He says that he's getting in touch with a doc in Tennesee who "invented the sling" and had done literally thousands of these procedures.  He'll let me know what he finds out.  Also, he scheduled me for a bladder study to see if there's is a over-active bladder problem.  Unfortunately, that's not  until mid-June before I could get an appointment for that.  I am on Detrol to help the urgency, but it doesn't seem to be helping.

 

The second opinion doc says to take a "tincture of time" and wait until at least 3 months post op before he would consider any other procedures such as "trimming down" the sling to help with the retention. 

 

It seems that neither one of them is seeing the entire picture.  Yes, I'm having a urinary retention problem, but it's coupled with an urgency leakage problem.  No matter how much I reiterate that it's both problems, they only seem to be able to focus on one at a time.

 

I guess I'll have to continue the fight as time goes on. 

---

Diagnosed: November 2008: - PSA 4.5 - 3 Cores out of 12 Positive - Gleason 6 (3 + 3)

Surgery: Nerve Sparing RRP on January 6, 2009, Age 53- one night in the hospital

Catheter: Removed on January 20, 2009.

Side Effects:    Incontenance - leaking like a sieve

(as of 1/27/09)  Impotence - half-staff with Levitra

April 1, 2010:

AMS Male Sling

AMS 700 LGX Penile Implant

 

 

 

Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16

Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in

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.

Imipramin 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 score=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

Appeared to help but gradually returned to pre surgery condition.

Back to 3-4 pads/day, stopped drugs, plan for AUS next winter.

Latest PSA 4/1/10negative.

 

  You have to make the decision that is right for you.

  Wish you well on your journey.

  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   

    http://www.healingwell.com/community/default.aspx?f=35&m=1219231