Pelvic sling surgery

[Bcgkelly]

I had my prostate cancer surgery in May 18 and am still suffering from incontinence & overactive bladder. Meeting a urologist next week and am wondering if anyone had a pelvic sling implanted and how it went. From what I know it won’t deal with the overactive bladder but may deal with the Incontinence which is mild to mid. Heard there can be severe side effects and am nervous about the operation as I developed sepsis after surgery last time.

[marnieg46]

Hi Bckelly.

I'm not sure if our experience and research into this will be of any help and if not useful now might be in the future.... It doesn't technically deal with an overactive bladder but rather general incontinence....so here goes with a bit of background ...

in September 2019 we were visiting Paris for five weeks and in the first week my husband developed severe flu and out of the blue became completely incontinent. Went from just a bit of leakage occasionally after prostrate removal to not having any control. Very inconvenient when you're away from your PC specialist, the health system you're used to and have a list of Paris sites you want to revisit! Our Sydney specialist gave us a referral to a PC colleague in a Paris hospital who undertook a cystoscopy determined my husband's sphincter had been made fragile by the radiation from 2016 and that coupled with the coughing had damaged it. He wrote in his report that if there was no improvement consideration should be given to an artificial sphincter. He provided a penile clip to be used for the long trip home and also some medication which had no effect. From my readings on this site some men do use the clip to manage what you are experiencing and it is useful for short term use but not really a long term solution.

Once we returned to Australia, via a contact I had initially made on this site I got the contact details for another previous poster who had an AUS 800 (artificial sphincter valve) for a number of years. This contact was invaluable as he provided a details history of how he'd worked through this issue and gave us some excellent links with further technical information. The AUS is still considered the gold standard both in the States and our country for severe incontinence. We did research the sling but were concerned that it has a lot of negative reviews for users. We're presently in the process of waiting for the necessary checks before my husband can be provided with the AUS device.

The specialist we are using in relation to the AUS had studied at Cornell Uni and had worked at Memorial Sloan Kettering and he did say that the patients for this device ranged from those who lost 'a few drops' to those like my husband whose QOL is severely impeded. Like all good professionals he offered advice on other solutions including the sling and told us what might go astray with the AUS but also said these problems are easily overcome. We'd done a fair bit of research of our own and were pretty well convinced that the AUS would be the right choice. As the person who provided us initially with his own experience said the real benefit is the QOL that the device brings and for us that's what we are seeking.

If you want to message me privately I'd be happy to check if this contact would share his experience with you.

My best wishes for the outcome that's best for your circumstances. Marnie.

[cujoe]

BCG,

I am the contact marnieg46 refers to in her reply to your original post and have had the AUS800 for three years. I had severe incontinence after RALP, 8 weeks IMRT, & 6 mo PT, so the chances for improvement from the 3-to-5 heavy pads per day were nil. The surgery is equal/more invasive than RALP, but in my case the results have been life-altering, in a very good way.

You are generally correct that is intended to deal with severe incontinence and not specifically with overactive bladder/urgency. The first step is to have a urodynamic evaluation to determine the nature and severity of the incontinence. If the cause is likely an overactive bladder, my guess would be a drug solution would be worth a try before considering any type of surgical intervention. I'm not familiar with those drugs, but here is a link listing most/all of them:

drugs.com/condition/urinary...

I have a local acquaintance who had post-RALP incontinence + a year out from surgery, but from his description it seemed to me to be more related to an overactive bladder. He was evaluated and had the sling surgery about six months ago and so far is 100% satisfied with the result. The sling seems to involve a bit of sorcery as it involves repositioning the urethra to improve/restore urinary function. As with all surgical procedures, my advice is to find an experienced surgeon who has done LOTS of any procedure you are considering. This would seem especially important with either the sling or the AUS800 as they both require significant judgement & skill in getting everything "just right".

Be glad to answer any questions you have here or you can message me, if you prefer. Here is a link to a comprehensive review of the various incontinence surgical interventions

ncbi.nlm.nih.gov/pmc/articl...

The study and the data are quite old, but at that time the failure rate for the AUS was about 25% at 5 years and 30% at ten years. (Should be better now??)

Good Luck & Be Well - cujoe

[Bcgkelly in reply to cujoe]

Thank you very much for your reply. I had cystoscopy in December and a Eurodynamics test last week. I am meeting the Urologist next week and wanted to prepare. So far I’ve tried Betmiga, Vesitrim & Cialis but they haven’t been much help at all. I have a friend that had the artificial sphincter implanted and going by his experience I’m not bad enough. Generally one pad per day. I appear to have two separate problems. Overactive bladder and low to mid leaking but it’s effecting my QQL. It’s particularly bad when I travel or am active. It strikes me that the pelvic sling is only going to help with the leaking and not the overactive bladder. Like you I was okay and nearly dry and has a dramatic increase in wetting. I also have severe SIBO IBS which they think is effecting my bladder.

[cujoe in reply to Bcgkelly]

Your are correct that the AUS would not be a good choice for 1-pad-a-day incontinence. (And I doubt any surgeon would do it for that level of incontinence.) If you have not already done so, I would suggest that you consider PT to confirm that you have mastered kegels and are using them effectively. That requires finding a PT who is experienced in MALE incontinence, as it seems most PTs deal with female incontinence issues of women after pregnancy.

My post-surgery issue was singularly one of severe incontinence. My erectile function returned after about a year and has now remained normal for 6+ years. My local guy seems much closer to your symptoms. He was also only needing a single pad, but had constant urgency issues that caused him to feel the need to constantly rush to the bathroom. In his case the sling has completely solved that problem. (He has not commented on his level of incontinence, but I assume it has not gotten worse and has likely improved from his pre-sling level.)

He also had major issues with ED, and used Cialis and Viagra with minimal positive effect. He most recently tried penile injections and had a VERY bad experience with an "erection lasting more than four hours" that required a very disconcerting and embarrassing trip to the ER. From what he told me, I believe his issue was due to the inexperience of his urologist that led to an injection "overdose". Irregardless of the cause, he has now scheduled a consultation with his sling surgeon to discuss the penile implant. It is an implanted device somewhat similar to the AUS.

In summary, if this patient's experience is a guide, it might indicate that if PT/kegels can't improve your current issues, the sling would possibly be a solution for both the incontinence and urgency problems. I can't provide much help with the intestinal issues, but would think some dietary changes, the right pre & probiotics, and a carefully researched selection of supplements could improve that condition as well.

Best of luck with your upcoming consult appt. Be Well - Captian K9

[Bcgkelly in reply to cujoe]

I attended a physiotherapist who specialised in treating male incontinence a year ago however it wasn’t much help. She did confirm I was doing the kegels correctly. Your friends experience is encouraging and if it worked for him perhaps it would for me as well. I will put the questions to the urologist on Tuesday.

[cujoe in reply to Bcgkelly]

As I indicated earlier, the sling seems to involve some modicum of luck as to results, since some get significant improvements and apparently others none/little at all. The better news is that, should you decide to go that route, the surgery is much less invasive than for the AUS and can usually done as an outpatient.

Hope you find a solution, since I know well what living with the constant fear of incontinence does to one's daily QOL. Restoration of confidence in urinary function is a true QOL game changer. Once again, Good Luck with next week's appt.

Be Well - K9

[ron_bucher]

A good friend had great success with his male sling after having stress incontinence cycling.

[julianc]

Hi I had RP in 2015 and sling 2 years later dur to mild incontenance usually 1 pad a day. I wanted sling rather than AUS so I could cycle. Overall it is ok not great. Incontenance is essentially cured ... I get minor leakage about once s month. On the downsides .... Basically it seems to work by putting a bend or kink in urethra so flow is much reduced. Also it's hard to fully empty and I often feel like I need to go as I think the sling irritates urethra a little. I think there is luck involved in how tight it's placed, and I hear there are ones now that can be adjusted with very minor surgery. I see little about other sling users but AUS users seem generally happy. Good luck.

[Bcgkelly in reply to julianc]

Thank you for a very clear response and it raises issues that I’m already concerned about.

[Bcgkelly]

I just want to let anyone that commented that I met with my Urologist and was told I wasn’t suitable for a sling due to my overactive bladder and the fact that my bladder is not emptying. He believes it will make both worse.

[cujoe]

Bcg,

Sorry to hear you got nixed for the sling. What did your uro recommend you do?

Be Well - K9 terror

[Bcgkelly in reply to cujoe]

Self catheterisation was what he recommended or a permanent catheter leading to a bag. I’m not happy. He gave me Kentera patches in the meantime and going back in about 3 months time.

[NPfisherman in reply to Bcgkelly]

How are things going with the Kentera patches.??

There is the newest drug--Myrbetriq and some info below from Mayo including Botox and an electric pulse implant wire--

mayoclinic.org/diseases-con...

Wishing you the best of luck...I have not searched clinical trials but that may be a possibility also...

Don Pescado

[Bcgkelly]

I haven’t been able to use the patches as I am allergic to them. I have already been told that Botox will not help me and the Urologist wants me to self catheterise as my bladder is not emptying.

[NPfisherman in reply to Bcgkelly]

Not sure where you are going but you may consider a 2nd Opinion at a Center of Excellence for Urology ...also perhaps treatment of SIBO and then evaluate how things are going--some info from Hopkins on SIBO:

hopkinsmedicine.org/gastroe...

A second opinion never is a bad idea when you are in a tough spot...Best of luck...

Don Pescado

[cujoe]

I would agree with the fisherman about 2nd opinion (at a Center of Excellence for Urology) and suggest you:

1. Get Successfully treated for the SIBO - to see how you urinary function improves as a result.

2. Find a medical solution to the urgency issue, if it remains after resolving SIBO.

3. After resolving 1 & 2, see what is your level of incontinence and determine if any intervention or other action is needed for an improvement.

Self-catheterization seems an extreme solution to me. Good Luck and let us know how it goes from here. Be Well - K9