A/S Considerations

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garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/8/2011 9:45 AM (GMT -6)   
I am nearly 3 years post RRP and am still incontinent to the tune of 1-4 pads per day. Night continence has gone out the window in the last month too. I'm getting ready to succumb to having an A/S installed. I've heard about a Dr. in Michigan who does a double cuff installation. Upon searching for this doctor [The name Dr. Bob Baladament was mentioned in the post] he doesn't appear to exist. I'd like my Uro to have a conversation with him before making final decisions.

So, my questions here are;

Is an A/S likely to stop stress incontinence from coughing? I have asthma and a chronic cough that makes for a lot of leakage.

What is the incidence of post-op infection?

What are all the downsides of having an A/S.

Thanks in advance,

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/8/2011 9:55 AM (GMT -6)   
Gary, Welcome to the Forum. I don't know any answers to your question, but we have several guys that will, so they may be along soon to help.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/8/2011 10:04 AM (GMT -6)   
Thanks for the welcome James. I look forward to sharing experiences and gaining knowledge here.
Gary

PSA 24.8. Jan 08
PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
RRP 04/29/08
Mucinous adenocarcinoma
Positive margins
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repair 7/10/08
PSA 0.02 Oct 2008
PSA 0.04 Decr 2008
PSA 0.06 Mar 2009
PSA 0.04 Apr 2009
PSA 0.07 Jul 2009
PSA 0.15 Oct 2009
PSA 0.17 Jan 2010
PSA 0.30 Apr 2010
PSA 0.71 Dec 2010

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/8/2011 10:57 AM (GMT -6)   
Welcome too, sure the guys experienced with that can help get you some quick answers
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 2/8/2011 11:15 AM (GMT -6)   
garyfoote,

My AUS was activated in July 2009, so its been operational for 18 months. I wear a light pad every day to catch the sneezing dribbles, as I call them.

I am not familiar with the double cuff installation that others have spoken to on this board. FYI, based on the number of pads you're using on a daily basis, I was more than double that number and only received the regular installation. Of course, your doctor will advise you on that.

As for the downside of having the AUS installed, I can't think of one. When I think of all the aggravation and inconvenience of always having extra pads, a change of underwear, cleaning wipes, etc whenever I left the house; almost any improvement would have been welcomed. Instead, I am better than I thought possible!!!

Wigs
Diagnosed @ age 46 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Suprapubic cathether installed - July 2008 @ Cleveland Clinic, OH
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
PSA < .03 - Aug 2008
Penile catheter removed October 2008
Suprapubic catheter removed December 2008
Colostomy Reversal - January 2009 @ Cleveland Clinic
Urethral stricture removed - January 2009 @ Cleveland Clinic
(Total incontinence - 4 diapers & 6 - 8 pads per 24 hour period)
PSA < .03 - Jan 2009
AUS implant - May 2009 @ Cleveland Clinic
PSA < .03 - May 2009
AUS activated - July 2009
(Wearing a light pad daily.)
PSA < .03 - July 2009
Penile Implant - December 2009 @ Cleveland Clinic
PSA < .03 - December 2009
Penile Implant activated - February 2010
PSA < .01 - April 2010 
 

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/8/2011 11:41 AM (GMT -6)   
Wigs,

I am at the total aggravation stage. I am 59 and was always uber-active before all this came about. Now I'm pretty much a recluse, only attending church and shopping. My urologist told me a year ago thaq the AUS would not stop leaks from coughing and sneezing. This seems contrary to the mechanics of the devise - closed down except when activated for urination. How can leaks occur if the urethra is cuffed closed?

So tomorrow I will have a long conversation wit my urologist about this again. I'm way more inclined to go forward with AUS than before. I guess I was just hoping I was a late-recovery case.

My PSA is rising and salvage radiation may be in my future. Will/should that impact the installation of an AUS?
Gary

PSA 24.8. Jan 08
PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
RRP 04/29/08
Mucinous adenocarcinoma
Positive margins
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repair 7/10/08
PSA 0.02 Oct 2008
PSA 0.04 Decr 2008
PSA 0.06 Mar 2009
PSA 0.04 Apr 2009
PSA 0.07 Jul 2009
PSA 0.15 Oct 2009
PSA 0.17 Jan 2010
PSA 0.30 Apr 2010
PSA 0.71 Dec 2010

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/8/2011 12:00 PM (GMT -6)   
Hey Gary,
Welcome to HW. Too bad you are still leaking. It certainly affects QOL.
I was leaking about the same amount as you and measuered my flow daily. I elected to have the AMS AdVance sling installed because I fit their ideal candidate requirements:
1) Leaking less than 200ml /day
2) Have residual control - able to start and stop stream but not hold it while standing.
3) Continent at night and sitting.
4) Able to wait 6-8 weeks before engaging strenuous activities.

So far this thing has been amazing. I can cough and there's no effect on flow. Before the sling, when I was urinating I could exhale or blow out as if blowing on a candle and my pee would squirt. Now, there is no effect at all. Great!

Time will tell if I will ever need any other mechanical assistance. But so far I am happy with it.
We leaker are all anxiously waiting to hear from knotreel - He had theAUS installed a day after my sling.

Good luck to you.
Jeff

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/8/2011 12:09 PM (GMT -6)   
Hey Jeff,

I wonder is an AUS can be installed if a sling fails to work properly. I fit the candidacy requirements for a sling. Might be a consideration.
Gary

PSA 24.8. Jan 08
PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
RRP 04/29/08
Mucinous adenocarcinoma
Positive margins
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repair 7/10/08
PSA 0.02 Oct 2008
PSA 0.04 Decr 2008
PSA 0.06 Mar 2009
PSA 0.04 Apr 2009
PSA 0.07 Jul 2009
PSA 0.15 Oct 2009
PSA 0.17 Jan 2010
PSA 0.30 Apr 2010
PSA 0.71 Dec 2010

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/8/2011 1:30 PM (GMT -6)   
Gary,
I checked into it. Yes. You can install an AUS after an AdVance sling if the sling does not work. I figured that was my backup plan.
Tallguy had that done. Search HW for his journey. Also John (malelslingproblems) had a lot of info.

Jeff

Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 2/8/2011 1:42 PM (GMT -6)   
Gary,

I wouldn't think that future treatments would affect the AUS. But one thing my doctor did tell me; depending on the condition of the urethra, i.e. after radiation, he would sometimes wrap some tissue around the urethra before putting the cuff on. It was his experience that the irradiated urethra would weaken due to the opening and closing of the cuff and could possibly cause problems long term. I mention that since you are saying salvage radiation might be in your future. You may want to ask your doctor about my doctor's comment.

Wigs
Diagnosed @ age 46 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Suprapubic cathether installed - July 2008 @ Cleveland Clinic, OH
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
PSA < .03 - Aug 2008
Penile catheter removed October 2008
Suprapubic catheter removed December 2008
Colostomy Reversal - January 2009 @ Cleveland Clinic
Urethral stricture removed - January 2009 @ Cleveland Clinic
(Total incontinence - 4 diapers & 6 - 8 pads per 24 hour period)
PSA < .03 - Jan 2009
AUS implant - May 2009 @ Cleveland Clinic
PSA < .03 - May 2009
AUS activated - July 2009
(Wearing a light pad daily.)
PSA < .03 - July 2009
Penile Implant - December 2009 @ Cleveland Clinic
PSA < .03 - December 2009
Penile Implant activated - February 2010
PSA < .01 - April 2010 
 

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 2/8/2011 3:42 PM (GMT -6)   
 Dr. Bob Baladament [urologist] is in the same practice as Dr Fred Lee at Rochester Urology in Mi.  ....www.rochesterurologypc.com......hope this is the doc you are searching for..................Cooper

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/8/2011 4:36 PM (GMT -6)   
Wigs - Thanks for the info. I'll pass it on to my Uro.

Cooper, many thanks for the link. If my Uro isn't aware of the double cuff [doubtful as she practices at Dartmough Hitchcock] I can now point her to some knowledge.

Gary
Gary

PSA 24.8. Jan 08
PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
RRP 04/29/08
Mucinous adenocarcinoma
Positive margins
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repair 7/10/08
PSA 0.02 Oct 2008
PSA 0.04 Decr 2008
PSA 0.06 Mar 2009
PSA 0.04 Apr 2009
PSA 0.07 Jul 2009
PSA 0.15 Oct 2009
PSA 0.17 Jan 2010
PSA 0.30 Apr 2010
PSA 0.71 Dec 2010

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/9/2011 12:07 PM (GMT -6)   
Do AUS devices stop leaks from coughing? I have a chronic cough.
Gary

PSA 24.8. Jan 08
PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
RRP 04/29/08
Mucinous adenocarcinoma
Positive margins
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repair 7/10/08
PSA 0.02 Oct 2008
PSA 0.04 Decr 2008
PSA 0.06 Mar 2009
PSA 0.04 Apr 2009
PSA 0.07 Jul 2009
PSA 0.15 Oct 2009
PSA 0.17 Jan 2010
PSA 0.30 Apr 2010
PSA 0.71 Dec 2010

garyfoote
New Member


Date Joined Feb 2011
Total Posts : 16
   Posted 2/9/2011 7:27 PM (GMT -6)   
Urologist said today that the double cuff is just a way of the manufacturer's reps trying to sell more. The urethra atrophy rate below the cuff's location reaches nearly 100% after 10 years, so a second cuff would have to be installed for almost all men by that time. Makes sense to me. And if they are considering that in my case it bodes well for what they expect to be my lifetime.

Another issue brought up was the need for super clean environment and super health going into the installation surgery. The risk of infection is, again according to my urologist, twice that for most other surgeries. They keep a sign on the door saying, 'IF YOU DON'T NEED TO BE HERE DON'T COME IN. Keeps the gawking interns out and the transfer of potentially harmful materials from the outside world to a minimum. Infections can pop up as much as two years later. If it does, the device gets removed and you wait 6 months and they try again. If there is even a nick in the urethra during the procedure they close and you wait 6 months to try again. On the day of surgery, if you have an infected hangnail you get postponed until you are fully infection free at the same time as a new scheduled surgery. Picky, eh? Makes you think about how serious you have to take this.

Also a complete physical one week before by the surgical staff's associates. I pray for the best outcome from my own installation, planned for mid-April. I pray for those having recently had, or planning to someday have this procedure. I'll keep you all posted on my own progress.
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