Artificial Urinary Sphincter (AUS) for older guy

[Lyubov]

My husband is 77 & totally incontinent following RALP (2014), IMRT & ADT (2016), several cystoscopies, & most recently following serious blockages Foley catheter for 2 months (increasing diameter size for dilation). The Foley was removed Oct 7. We were devastated that he's totally incontinent. He's doing Kegels but no progress so far. Scheduled to start PT Nov 9 (!). Depends now 24/7. Also watching (very low) 6-month-doubling PSA: 0.05; 0.09; 0.18. PSA check early January. Then urologist & med onc. Just wondering if AUS could be an option for him. Any thoughts are welcome.

[Rocketman1960]

Hello Lyubov. I have no personal experience with a AUS but a close buddy of mine has one and is grateful for the added control it gives him. Here is a sample size of 1. Good luck.

[Tall_Allen]

Everyone I know who has one, loves it. What is the downside?

[Lyubov in reply to Tall_Allen]

Maybe I need to ask another question. Does it require surgery to "install"; don't know if my 77-year-old hubs could withstand surgery. But that's a question for the docs, anyway. Thanks for responding.

[Lyubov in reply to Tall_Allen]

Anyway, may be moot at this point, as he's developing blood clots again!

[tango65]

It requires surgery with general anesthesia. You need to talk with the urologist about the procedure.

[Lyubov in reply to tango65]

Thank you, tango65! Yes, that's a concern I have. Hubby is 77 & has already been through a lot: RALP, IMRT, ADT, several cystoscopies, two under anesthesia (1-hr long). So, we'll have to rely on the experts. . .

[kaptank]

I have had 2 of these implants. AMS sphincter 800. The first failed after about 10 years, (age 65) pretty much an average life. My uro said that he thought I could have another when 75, depending on assessment for anaesthesia. If you are in the Sydney area I recommend:

Dr Phillip Katelaris, 51 Palmerston Rd Hornsby 2077 NSW. Ph 02 9477 7904. He does surgery at the Adventist hospital in Wahroonga (the San). He does a lot of this surgery, probably as experienced as any. There is accomodation for family of non local patients.

[marnieg46 in reply to kaptank]

Just to add a bit to your information kaptank and another contact for an AUS 800 in OZ.

Our PC specialist is at the SAN and he recommended Dr Tom Jarvis from Prince of Wales Randwick as being particularly skilled in this procedure. Tom has also worked at Memorial Sloan Kettering in the States. We found him to be very thorough and personable and although my husband wasn't suitable for this procedure he made every effort to explore other options and provided considered advice about a way forward.

[kaptank in reply to marnieg46]

Thanks. Good to know.

[marnieg46 in reply to kaptank]

My pleasure. I think it's always good to build up a list of specialists in various fields because what we've found is that this gives you some choice about who is the best 'fit' not only for the condition but for the person as well.

[Lyubov]

Glad to know it's working out for you & if you need another you'll be able to get it. Fear my husband may not be a good candidate for the anesthesia at 77 yo. He's been through tough times, as most here have.

[arete1105]

I was talking to someone with PCa and because of his incontinence, they sewed in a battery operated control in his scrotum which controls a syphincter valve. He says when he needs to pee, he pushes a bottom on this control unit and he can pee like a race horse. Turn the button off and he doesn't leak.

I don't think this requires a general just local.

[Lyubov in reply to arete1105]

Boy this sounds like a great device, but hubbie's now developing blood clots (scar tissue) again. That's what started this whole merry-go-round in the first place. So hard to be optimistic.. . yet I keep telling him we can't despair!

[E2-Guy in reply to arete1105]

This sounds like a cool device! If anyone has more info about it, please share?

[Engraver68]

It was a life changing procedure for me.

After prostate removed and radiation I really struggled to control bladder.

I was using up to 5/6 pads a day and as very active my lifestyle was restricted severely.

I had the AUS fitted just coming up to 8 years ago now, a complete success! It is a bit inconvenient to have a pee as the lozenge is in testicles and you do need to sit on toilet to be able to release the valve

It is possible to stand but trousers are around legs, so can be embarrassing if in a public toilet.

A small price to Pay for such a major advantage.

The surgery is quite invasive but providing you manage the swelling and pain relief not a problem.

Go for it!

[Lyubov in reply to Engraver68]

Hey, thanks a bunch for sharing this. I'm fearful we may not get to try the AUS. The scar tissue is acting up again & big blood clots forming. . .

[kaptank in reply to Lyubov]

It's important to get to the source(s) of the problem. In my case there were multiple causes but the 2 most important were a result of a lot of disruption to the sphincter and lower bladder, previous surgery, RT many catheters etc. Damage to the sphincter muscle and a very sensitive bladder that contracts to expel anything in it (very often this can be addressed with drugs).

When you refer to scar tissue I assume you are referring to radiation damage to the lower bladder. Scar tissue can break off and cause short term bleeding in the urine. It can happen years later. It's generally not a great problem but it is very important to confirm that it is the source by putting a scope down there.

[Lyubov in reply to kaptank]

Seems it's damage from ralp (2014), IMRT (2016) & several cystoscopies, & the camera procedure to clean out. But the scar tissue keeps coming back & that's what I don't understand. Will pursue with uro.

[Survivor1965]

Im 54 post radical prostatectamy and struggling with leakage. Been considering having this done but I already have one device in my scrotum, the penile pump, and wondering if having another object in the sack would be a little crazy.

[kaptank in reply to Survivor1965]

I have both. No problem. I had the first pump and sphincter installed together. After 10 years, replacement of the sphincter was done without disturbing the pump.

[Survivor1965 in reply to kaptank]

Test

[Survivor1965 in reply to Survivor1965]

Thank you! Glad to hear your pump is still functioning good after 10 years. I may bite the bullet and get the valve.

Many thanks, J

[Break60]

I’m 76 and have stress in continence ( pee when coughing, laughing, blowing nose , swinging golf clubs ,etc.) I’m seeing my urologist about possible surgical fix.

[Fairway]

Not the end of the world. I was totally incontinent after prostate surgery at 70 and after some queasiness went for the AUS, which while not a perfect solution is the much better alternative than diapers. The surgery is not a walk in the park. Two week recovery and one bout in the ER. Write if you want further info.

Fairway

[Lyubov in reply to Fairway]

Thanks, Fairway. I'm not even sure he would qualify for the AUS. They've already poked around so much in that region, that I just don't know. He might require even more complicated fix. . .have to find a good urological surgeon.

[Fairway in reply to Lyubov]

I know a good one if you're near Los Angeles. Best of luck. Fairway

[Lychee1576]

I had prostate removed and radiation, I struggled to control bladder,6 to 8 pads per day.

I have had the AUS ,for 8 years now, an a complete success! I put a pad on after my evening shower and remove it the next evening at shower time. My AUS is not total control , I was told, a slight leakages is preferred to prevent blood clotting .

It is possible to stand at a public urinal and easily complete your task. I stand with legs spread, unzip pants let then hang on my hips. I lower my jockey shorts and let my man hang over the short, then release the bulb in my scrotum. I have used this method for years and never embarrassed.

I would recommend the AUS procedure to anyone with bladder control problems.

The surgery is invasive, it was no problems until catheter was removed, then I had some clotting problems in the urethra. It was cleared with saline solution.

[j-o-h-n]

My opinion, At 77 I think I would prefer a poke in my eye with a stick....

Shop Costco for a good price of a carton of Depends......

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/01/2020 5:53 PM EST

[keys2life in reply to j-o-h-n]

Have to agree. Judicious use of pads, using bathroom frequently even when no urge to do so and avoiding alcohol can make a big difference. The anxiety and recovery of the aus surgery would put me right over the edge

[Lyubov in reply to j-o-h-n]

But not that simple. Still has to self-catheterize 3 or so times each day because the urethra incurred so much damage from radiation followed by several cystoscopies & foley 24/7 catheters, blood clots, urine retention. He's "managing" but it's almost all-consuming. Yet, do not see surgical options at his age. Sometime I just think it is the beginning of the end.

[Hidden]

This is his impending QOL issue . There is a fix . We do what we have to do .. Best of luck to him in a fix ASAP 🙏