I've had a number of previous threads where I talked about
events and thinking that led to my decision to pull the trigger on these devices, notably --
- The World Will Never Know... which talks about pre- and post-surgical ED, my odds of recovering erectile function, and my penile rehab.
- Slings and Radiation which talks about my incontinence (including a link to a graph showing it was getting worse, not better) and a discussion of being torn between a urethral sling and an artificial sphincter.
- My Device: A Modest Proposal a thread with quite a few funny comments which shows that I was already kicking around AMS 1500-ish ideas 2 1/2 months after my RARP.
I am starting this new thread as a sort of journal with my experiences with my new devices. I'll start with my surgeon's notes:
Date of Operation: 01/05/2015
Preoperative Diagnosis: Erectile dysfunction, vascular, and stress urinary incontinence.
Operation Performed: Insertion of AMS artificial urinary sphincter and placement of AMS 700 CX penile prosthesis. Additional procedure was cystoscopy
and placement of catheter.
Procedure in Detail: Following satisfactory anesthesia, the patient was placed in a modified frogleg position. The abdomen, penis, scrotum, and perineum were prepped with ChloraPrep and sterilely draped. The area around the navel was also prepped for Dr. --- who proceeded with an umbilical hernia repair which will be separately dictated. I next placed a 16-French Foley catheter and made a penoscrotal incision, dissected and made a pouch under the internal ring on the left side for the reservoir and on the right side for the gradient pressure balloon. Dissection proceeded to the most proximal urethra and the bulbous urethral area. It was then measured and at 4 cm and a cuff placed around it. The gradient balloon was placed in the right pouch area and the valve in the right hemiscrotum. The gradient balloon was filled to 23 mL of water and was connected and placed and deactivated. Next the tunica albuginea was identified on both sides for the corpora cavernosa and each side was measured at 12 + 9 and an 18 cm prosthesis was elected to be utilized. This was utilized with 3 cm extenders on each side and a low profile 100 mL reservoir for the left pouch. The reservoir was placed in the left pouch and appeared to be under the muscle layer although it could be palpable and was filled to 90 mL. The cylinders was placed in the penis without any difficulty and laid flat. Minimal dilation was done of the corpora, but they fit nicely. The corpora of the tunica was closed with running 2-0 PDS. The prosthesis was cycled and the pump placed in the left hemiscrotum. The tissue was closed in 3 layers of Vicryl and 2 layers of 4-0 Monocryl. At the completion, attempt to pass a 60-French Foley was unsuccessful even though the valve was deactivated. Cystoscopy was also unsuccessful at getting passed and we felt that the measurement even though performed twice was too small. Therefor the wound was opened and the cuff changed to a 4.5 and placed more distally and a 12 passed without difficulty. The device was cycled1 and was deactivated again and then closed with 3 layers of Vicryl, 2 layers of 4-0 Monocryl and skin glue the skin. The patient was relieved from anesthesia and taken to the recovery room in satisfactory condition.
1: The dictated report said "The tissue cycled" which I corrected to "The device was cycled" which he probably intended.
I will attach the other surgeon's report (the hernia repair) as a comment once I get a copy. For the purposes of this thread the main contribution of the hernia repair is that it makes it almost impossible for me to speak to how much discomfort is associated with the recovery from implantation of an AMS 1500 combo. All I can say is that it is a whole lot less than having your abdominal muscles shredded, moved about
, and repackaged using almost two square feet of mesh.
It could be that some of this lack of discomfort was the long-lasting pain-control "secret sauce" that my surgeon squirts in which keeps the package pretty numb for up to three days.
For the first 24 hours I had a narrow Foley catheter in place. I don't think this is usual but my surgeon was probably a bit nervous about
that too-small cuff that wouldn't pass a catheter so he played it a bit safe.
All of the nurses "wanted" to look at my incisions (part of their job -- earning their pay) and, because I couldn't lift my head much, or my shoulders at all, I had to take their word that the penoscotal incision looked OK. Several of the nurses wanted to know if there weren't other incisions somewhere else because the one on my scrotum didn't look big enough to have used for all that I had done. Scrotal skin is really stretchy and a hole big enough for my surgeon to get his fist inside showed as an inch when all glued shut. As well as being unable to raise my head and look, there was the problem that the incision was on the other side of my member which the surgeon had left 3/4 erect to discourage bleeding.
I wound up being in the hospital for four days instead of the expected one. The main problem was that for the first 48 hours I was pretty much a beached whale from my inability to use my abs for anything. When they lifted the head of the bed to sit me up I would gradually slide down toward the foot and they would have to put the bed into upside-down mode so I could slide back to the head. Towards the end of my stay I could get up and walk but everything
hurt. When they were getting me up to walk was really the only time that I noticed much discomfort from my scrotal area. The nurses were all about
getting my feet right before I slid my butt too far off the side of the bed but I was eager to get my weight off of my swollen scrotum and, besides, my feet
hurt, too, and I had other opinions about
where I wanted them. (My sore feet turned out to be gout which I only figured out when I was home. A few of my magic gout pills and I was OK.)
So, as I write this my AUS remains deactivated and will remain so for another four or five weeks. I saw my surgeon earlier today and he let a bit of water out of my penile implant so it is not quite so firm. Things are still somewhat swollen and sore and it sort of hurt for him to manipulate the pump but it didn't take long and it wasn't particularly bad. I see him in another two weeks at which time he will probably teach me to use the implant pump and we will talk about
my possibly going back to work.
Some of the guys here who have had these devices talk about
the doctor instructing them to tug on the tubing periodically to make sure the device rides low enough for easy access. I asked my surgeon about
that and he said that it was the "voodoo that we [ doctors ] do to make sure things wind up where they need to be." But, apparently, he was happy with the
location of my various control doodads and didn't think they needed any tugging, at least for now.
A few random things I have noticed so far:
- The penile implant gets surprisingly hard before it gets big. I am not sure a soft chubby will be possible. I may still need that sock for my speedo.
- If you google for images of an AMS 700 CX you will notice that the cylinders have rubber nose-cone type things on the end. These will probably be palpable as lumps behind the glans even when the device is deflated. May take some getting used to.
- My device, including the 3 cm extender (that goes in the back end) is 21 cm (8 1/4 inches). If you get an AMS implant you should be careful in your Googling not to read comparisons with the Coloplast Titan device, the main benefit of which is that it comes in much larger sizes.
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Incontinent, Trimix, VED, (AUS Planned)Forum Moderator - Not a Medical Professional
Post Edited (PeterDisAbelard.) : 3/18/2015 8:16:12 AM (GMT-6)