Sling vs. Artificial urinary sphincter

[Skip66]

I had my surgery in August of 2021 to remove my prostate. Since then I have been doing pelvic exercises which helps where i do not need to wear any depends or pads.....My question is as it relates to sex. Sexually I enjoy bottoming but I am really worried that I may start peeing if I get too excited...I do drain myself as much as i can but still worried about the possible leakage...

My Dr mentioned that I do qualify for both of these options but I want to get some advice from others that may have been in my shoes.....

Thanks

Skip

[thudson1965]

I hope you get more responses this year - Below is my updated response when you asked December 2021.

I am very pleased with the sling. I was in the toss up area between sling and AUS. I opted for the sling and followed the recovery guidelines of not lifting anything over 10 pounds for 6 weeks. I started back walking slowly and short distances and built back up to my 2 mile walks.

Updated December 2022

I chose the male urethral sling surgery. I was leaking 17 ounces a day - 3 pads and a depend pullup. I have about a quarter of an ounce leaking with the sling at night. I am a side sleeper. I think rolling from side to side and the bedtime medication causes the small amount of leakage.

I had the surgery 12 months following RALP. It has been 15 months since my sling surgery.

The sling surgery is typically once and done. The AUS has to be redone in 7 to 15 years with most men having problems around the 10 year mark.

I took a stool softener (100 mg twice a day - generic Colace over the counter) for 3 months and for the first 2 weeks a does of generic Miralax in my morning coffee then half a dose of Miralax for weeks 3-6 to make sure constipation would not cause any problems with the sling.

[Tall_Allen]

Here are my climacturia tips:

• Restricting fluids for a few hours before sex, especially coffee, tea, Coke, alcohol and fruit juices

• peeing before sex (sit down and rock around or in the shower - whatever it takes to fully empty the bladder)

• a constriction band around the base of the penis (also helps maintain erection)

• lay down on your back and don't change position

• use a condom

• get rubber sheets, and just enjoy water sports

Unfortunately, I suspect that ED meds (like Cialis) may make it worse.

[PCGeorge]

I had my radical prostatectomy in November of 2015. I hand the AUS device surgery in February of 2017. I am happy with the results. I do have some minor leakage on occasion so I wear a very light pad daily. I believe most of the leakage is not waiting long enough after urinating, thus not giving the time for the device to fully close. To be honest I dread the surgery to replace it if that becomes necessary but I suspect the surgery for the sling to be similar. The Sling has a bit longer of a life but only a few years I think. So, bottom line, I am confident with my AUS device. I had my surgery for it done at Memorial Sloan Kettering. Good luck with your decision and moving forward.

[Thomkin]

Hi Skip- I'd be grateful you're continent after your RARP with exercise! I don't think additional surgery (Sling or artifical sphincter) with their risks would be worth it. I think an understanding partner won't have a problem if you leak a bit- just pretend it's pre-cum or ejaculate like pre surgery!I had mild/ moderate incontinence after surgery which persisted over a year. And yes, I did have 'climacturia' with sex. The incontinence, not the climacturia, was much more disturbing than ED issues. Last Oct., I had the Sling procedure at UCSF and am very happy to be almost completely continent now. I no longer have climacturia, but that alone would not have motivated me to have surgery.