My dad is now roughly 10 months post surgery, after having his prostate removed. He had a rather aggressive form of prostate cancer. Since then, he’s pretty much been completely incontinent. He’s discussed it with his urologist over the many months, and on today’s visit, he was referred to a specialist. According to my Dad, the urologist suggested that they could install a sling. According to my Mom, the urologist suggested that they could install an artificial sphincter. According to the internet, both of these are potential treatments.
Now…Dad isn’t a healthy person. He’s overweight, diabetic, suffers from diabetic neuropathy, and is generally clumsy. My sister and I also think he’s slowly losing his memory - his GP recently put him on Aricept…and the only on-label use I can find for that is early Alzheimer’s. So I tend to believe Mom’s version of the report. But my reading on artificial sphincters suggest that you need to manage it properly.
Does anyone have any experience with either procedure? Dad’s appointment with the specialist is set for Oct. 30th, with a target of surgery in January of 2013.
*Side note - Dad is on hormone therapy, because his PSA was still elevated after having his prostate removed. His urologist would like to do one of these procedures, and then hit him with radiation. My brief read this afternoon suggested that the sling isn’t as good an option in this case.
I’ve had two artificial sphincters (AMS800). They work…
Had my first one when I was 12 in 1988, revised to lengthen the tubes that run from reservoir to pump and cuff in 1993 due to growing taller.
Failed slowly but not completely around 96-97, had it totally replaced in 1999 (had to delay the surgery for a variety of health and non-health reasons).
Worked like a charm ever since.
I have a completely different diagnosis, and I am considerably younger than your dad, so his results may vary, but its the gold standard for urinary incontinence.
Btw artificial urinary sphincters need no management, other than a yearly X-ray to check for punctures. But bear in mind that you do need the dexterity to squeeze the pump properly.
My reading indicated that there is an open position, a closed position, and a lock. Is that right? How much dexterity do you need? And how easy is it to get something wrong?
Also, could you talk at all about the procedure? How long it took, what the recovery was like? I read that you spend a few weeks afterwards with it open before you’re allowed to start using it.
There’s a tube? I thought the sling was a passive device that just held the bladder in place. More to read about, I guess.
Thanks again, Szlater and not what you’d expect.
Catheters are also common after bladder/related structures surgery while initial healing is taking place. It does not necessarily mean the operation was a failure. Most people do find urinary catheters unpleasant to one degree or another.
The sphincter is implanted in the locked open position, after the surgeon switches it on (a firm squeeze on the lock button) it defaults to the closed position. To urinate, that is activate/open the sphincter, it takes two squeezes on the pump. The saline is then pumped from the cuff to the reservoir removing the constriction on the urethra (or bladder neck, if implanted there…possibly both as there are some surgeons implanting two cuffs now), and then over a period of about two minutes it returns to the cuff once again closing off the flow of urine. Generally two minutes is enough time to empty the bladder, and you only manipulate the pump to open the cuff, not to close it.
It matters on which side of the scrotum they implant the pump because if you’re right handed and they implant on the right you will struggle to work it with you right hand. You need a fair amount of dexterity in you thumb and index/middle fingers to activate the pump as they can be very stiff especially early on. You also need to monitor the pressure needed to activate as difficulty activating can indicate a leak in the system.
Not really, the procedure for my first implantation was done 25 years ago when surgery was very different, the second was complicated because of my medical condition and the fact that they had to remove the broken sphincter. My recovery time for the second op was about four months (off work).
As for how long they leave the sphincter inactive, they left my second one inactive for six weeks, during which time I had a supra-pubic catheter to drain the bladder. The catheter was removed once the sphincter was confirmed to be active and functional, they don’t want to leave you unable to urinate with no way of emptying your bladder.
Yes, whatever urological op is done, it is almost certain that they will drop a catheter or two in if they have done any monkeying about. The most I can back from surgery with was four (urethral, supra-pubic and two uretal shunts)and two wound drains. But the sphincter ops, had two catheters (urethral and supra-pubic), they sent me home with the supra-pubic catheter, which was manageable.
You acclimatise to a catheter very quickly, they’re not the most pleasant thing but an in dwelling catheter should not stop you living your life.
I now intermittently catheterise through a stoma and it took a couple of weeks for it to become routine, but it did.
Removal of indwelling urethral catheters feels weird, but not painful. Supra-pubic catheters though can be agony depending on how well your body has healed, the more healing you have done the more painful they are. I always seem to get the painful extraction.
The sphincter can be activated and deactivated (functional or locked open) by squeezing the lock button on the pump, which can be done in the doctors office. You really can’t do it by mistake as the pressure needed is quite a bit more than normal use, and it hurts a bit to exert that pressure (look where the pump is placed). The lower half of the pump, which is what you squeeze to urinate is also a different texture, with a much softer feel and therefore is much easier to squeeze and not painful at all.
As part of his diabetes, my Dad suffers from peripheral neuropathy - we know he’s lost considerable feeling in his feet. I don’t know if his hands have suffered.
Would that concern you, as a user?
Thanks again. This is helping us figure out some questions to bring up when he sees the specialist.
-D/a
I would want to check that he can manage to manipulate the pump. Ask the specialist if he can have a go with a sample sphincter, they almost always have a prop one hanging around for you to look at and play with. I’m sure the surgeon will want to make sure he can manage before he goes ahead with any surgery.
The sphincter will release when the pressure in the bladder gets high (to prevent damage to the bladder and kidneys), so he won’t be stuck unable to urinate, if he develops peripheral neuropathy in his hands at a later date. It’s to pleasant though and is painful to reach the release pressure.
It is possible, so my specialist told me, that continence can be restored by implantation without activation. In some people the deflated cuff is enough to restore bladder control…but I wouldn’t bank on it.