I am looking for your experiences- Have you had an AUS or Sling? How old when you got it, have you ever had one fail, what was the procedure, recovery, and efficacy like?
It's been a two and a half years after my RARP, and I'm still quite a bit leaky. On very physically active days, I can still soak a good 3-4 heavy pads. Even standing and working in the kitchen gets me running.
Sick of being soggy, perpetually itchy and raw down there, and as much as I hate the idea of messing with my remaining plumbing yet again, I think it's time for me to look at some options.
I went to see a local urologist who specializes in Artificial Male Sphincter implants, on a referral from the urologist who treated my cancer. He examined me with a Cough Test, which triggered a good deal of leakage and dribbling, as well as an unexpected cystoscopy. He told me that I would be better off with a sphincter than a sling- no surprise there. Pretty much everything he told me agreed with what I already knew going in. (He never did give me anything for my cough, BTW.)
My story: My PC was well-contained, and since my RARP, I have not needed any radiation, chemo, etc. The main thing I worry about, however, is that at 57, I am well below the average age for the AUS implantation. I hate the idea of such a foreign body in me, especially given a failure (urethral erosion requiring explantation) rate of almost 6% in the first year or two based on some studies I have read.
Unfortunately both Urologists told me that this far out, the incontinence is not likely to improve on it's own at this point.
I met my primary Uro in May for a PSA followup and I am still in remission.
BTW, I have 100% ED, as well. So far, pills don't work at all. I have had some success with a concoction of alprostadil and lidocaine, following my one attempt at trying Trimix that was so painful, it would have been worthless anyway.
Thanks, all!
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DS_WAVL
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Everyone I've talked to that had the AUS loves it. It is the alprostadil that causes pain - you can get trimix made with a lower dose of it, or get bimix made without it.
I have an AUS. It was installed in 2017 when I was 53 years old. That was about 10 years after my RRP. I have not regretted it a single day since having it installed. As for the experience, I had more pain after surgery than I expected. Looking back, that was because they had to tunnel from the urethra to the reservoir. The pain did not last long.
I've been told that individual results vary and that even with an AUS, 100% continence is not guaranteed. Does yours ever leak? If so, what sort of activities make you leaky?
I continue to use a pad in my briefs. I’d estimate control at greater than 98%. I find there are the rare seating surfaces that can deform the ring and cause a small leak, but that’s about it. I used to have to know I could use a restroom every 60-90 minutes. With the AUS, I can go several hours. For me, it’s a life changer.
I don't know if this device is different than the AUS or sling, but I was talking to a gentleman up at USC, we were both getting the NSF scan, and he told me he had leakage problems after his treatment so what they did was to insert a valve in his line and a battery(DC) operated button. One push and it shuts off his flow. When he feels the need to pee, he pushes it again and pisses like a race horse. He says it works great. He did say he does wear a pad, but no major problems.
I was 71 yrs old when a male sling was installed and the results were amazingly good, 100% continent under all situations.
However, after about 4 yrs, a small amount of leakage has started to develop under some conditions. i understand that the sling stretches over time and becomes less effective. still not a major problem to warrant another surgery.
the sling surgery procedure is painless, you are sent home the same day and it is effective immediately.
I'm 67. After 3 years of sitting in soggy adult underware, I got an AUS. My only regret is that I didn't get it sooner. As others have said, it's not 100%. I've had a few leaks. But it's 1000% better than before.
A few days ago Our expert here at the U of Minnesota (Dr Elliot) said neither the sling nor artificial sphincter was an option for my husband recent daytime leakage. He also mentioned some type of filler that takes the place of the missing prostate.
Hubby has had LRP, radiation and seeds. He has been mostly continent/dry for 17 years since RP 2002.
If your expert says you are a candidate I would do it. Even if it fails after a few years there might be new devices by then.
They gave my husband a clamp which so far he likes better than leaks.
I had a radical prostatectomy 1999 at age 45. In 2000 I had the AUS implant. Best decision I ever made, it finally failed at age 61. I have had it removed and can hardly wait for the 6 months to get another. Because right now I feel like I am back in 1999.
DS - I'm kind of late to comment on your post, but would agree with YostConnor and the other positive comments on the AUS800. The surgery after effects were actually worse than from the robotic RP (and the one month wait for activation makes for a delayed reward), but the change in QOL is unmatched. It is referred to as "the gold standard" for incontinence intervention. I refer to it as being able to "pee at the press of a button".
I also still usually use one Depend Shields light pad per day, partly because I go to the gym daily and strength training can produce some leakage. That is a VERY significant improvement from the 3-5 heavy pads I was going through prior to the AUS.
As with any surgical procedure, I would recommend finding a surgeon who has successfully done many of them. There are also several thorough reviews of the various sling/sphincter devices available on the internet.
In a month or so, I will do a review of my surgery. (done about 28 months ago.)
Be Well and feel free to ask any specific questions. - cujoe
Don't get a sling, they do not work with total or major incontinence. About 12 years ago (age 55) I had implanted the American Medical Systems (AMS) 800 urinary sphincter along with the AMS 700 penile prothesis. Both work brilliantly. The AMS 800 failed at about 10 years (the average I am told) and I had another implanted. I continue to use some pads for the leakage. The 700 has no issues.
Hi my husband has kidney tubes now he’s thinking about a urostomey the other suggestion was a sling but said since he had radiation and now major complications from his salvage prostatectomy it would probably fail, .
I had a sling implanted a year or so before I had the AMS implants. A complete waste. The important thing for the AMS 800 is that there is a short length of good urethra tissue, not radiated and not scar tissue. That can only be determined during surgery. There is a good chance. I too had a badly botched radical prostatectomy, followed by radiation and sling and corrective surgery after which I came to know the extent of the damage and sought a surgeon able to address the underlying cause. He did the AMS implants and even found a length of good urethra for the second install and reckons he can put in a third if needed. I can't recommend the implants enough if you have major incontinence. The AMS 700 is great. Got a life back.
Sydney Australia. probably too far. Ask your urologist. Ask on healthunlocked too. There seem to be a few of us here. You need a surgeon that has done this successfully many times. There are quite a few these days.
I’ll relate my experience in hopes of helping you make the right choice. I had the robotic RP in August of 2017. The surgeon is renowned and had performed over a thousand such operations.
As you will note below, those guys don’t always give us the downside of the surgeries they sell. My doc failed to mention that I would lose length as a result of having to cut the urethra on both sides of the prostate and then stitch the urethra back together. I lost around 3/4”-1”or so but I had some to spare so I wasn’t terribly disappointed.
The RP left me with severe incontinence. 24 months out I was still using 6-8 heavy pads so I decided to pursue a solution. I went to another renowned surgeon and was told I was a perfect candidate for an Advance XL sling. Because I don’t like the idea of the AUS valve in my scrotum I decided to have the sling installed. The surgeon knew I had undergone follow up radiation. According to the literature, that made me a higher risk for sling failure. The doc assured me it would present no problem.
He failed to mention that I would lose more length. After that surgery I was an additional inch or so shorter.
I chose that surgery partly because I was assured that if it failed I could have an AUS put in. I’m now being scheduled for the AUS surgery and only now is the doc informing me that the sling can’t be removed due to tissue in growth. Accordingly, my length loss is permanent.
If I had known all the above facts I would have chosen other options.
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Incontinence after RP and ADT
Urinary leakage before radiation 
Urinary issues post-catheter removal
Artificial Urinary Sphincter 
