AUS

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I haven’t seen a lot of discussion regarding Artificial Urniary Sphincter surgery, so I thought I'd toss it into the mix and see if I get any hits.

I'm about a year out from radical robotic prostatectomy surgery and underwent several months of PT which seemed to help until I stopped doing the exercises. My surgeon recommended a consult with the Director of Urologic Male Reconstruction and Robotic Reconstructive Surgery at Northwestern Hospital here in Chicago, who is very enthusiastic about the ASU.

He recommends the male urethral sling only for patients with mild-to-moderate incontinence. Mine is considered "severe" at over 100 milliliters per day. The problem is, I'm an avid bicyclist. It’s my primary vehicle of choice for commuting, running errands, exercising, and general recreation. He recommends less than 1 hour per day (ideally, none at all) as it places all the weight of the body on the perineum, where the device is located. "I guess it all depends on how important bicycling is to you," he said.

That was yesterday. Today, I'm thinking I should hop back on the PT wagon, give it all the attention it deserves, and see where that gets me before deciding on any extreme surgical procedures. Significantly, the AUS cuff has a life span of about 8 years under the best of conditions, which would get me to age 76.

Currently, I can bicycle all I want without much of a problem. But I go through 3 to 5 liners a day, depending on my level of activity. With the pandemic, I've had the luxury of working from home as a graphic designer. But at some point, that will have to change. I have also had to forego weekly sessions with a personal trainer until I can get this more under control.

Thoughts? Suggestions? I'd appreciate any knowlege or experiences you have to share.

 

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My recommendation is to exhaust all alternative treatments before opting for additional surgery.

It may come to that but from your posting it seems that you have some doubt and feel you haven't given the rehabilitation all the attention you should.

Alternatively if you are down to minor leakage you may want to opt with using a pad and just live with it.

Bottom line: there are other options you should explore before opting for surgery.

My 2 cents.

 

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Thanks, I appreciate your feedback. It confirms my own suspicions.

 

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Patients who are avid bicyclists typically will replace their regular bicycle seat with a split seat or with an area in the seat that reduces pressure on the area where the cuff will be located.

Example of a website that carries these types of seats. https://www.bicycleseats.com/bicycle-seats-men.html

Good luck

 

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Thanks, interestingly, I already have a seat like this. But my position is leaning forward onto the pedals, not seated upright. So I haven't found it all that helpful.

 

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I would welcome feedback from patients who have had the male mesh sling surgery. I use 1-2 pads a day, over two years since my RP. Despite intensive physical therapy I made little to no progress over the past 18 months.

 

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I was in the same situation. Had physical therapy faithfully practiced Kegels and exercised regularly. Nothing helped the incontinence persisted. On December 20 I underwent AUS procedure at Washington University school of medicine in St. Louis. There has been moderate pain and discomfort for about two weeks or so. I’m looking forward to it’s being turned on in February after six weeks of the procedure. I believe that after one year more physical therapy at Cetera may not be the answer. AUS surgery is about an hour outpatient procedure. You go home 23 hours later with a catheter during the brief hospital stay. Good luck to you.I hope these thoughts are of some help

 

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Thanks, Marcel. Keep us updated.

 

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C...,
You might want to give our patent-pending aid a try, which has not yet been tested on a bike, but may perform equal or better than with feet on the ground. Unlike the clamps and straps, it's a flexible sleeve-like device that puts upward pressure on the urethra restricting flow. It can be worn all day and all night, if necessary. Since it's flexible, addressing the comfort issue, it allows some leakage under stress conditions, which may or may not include cycling. We still welcome input from our testing volunteers, whom you would be joining. Info is available if you send me a note at amhelp@comcast.net Fynlee

 

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I was 1 to 2 pads per day. I had robotic surgery for radical prostatectomy in Aug 2018. Then I had radiation in Feb-Mar 2020 I had tried PT and kegels and various meds. My incontinence got much better before radiation, then it got worse about 6 months after radiation was done and stayed at 1 to 2 pads per day. I opted for the male sling surgery in Nov 2021. It has been 7 weeks and I have been 100% dry since the sling surgery - so it was a godsend for me. My thoughts was that the AUS was just too invasive. The sling is a much more simple procedure. I had the Advance XP sling manufactured by Boston Scientific. It was not painful, but was uncomfortable for about a month - got better each day. You have to be careful for 2 months, then good to go.

 

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It all depends on the level of incontinence.with 1 to 2 pads a day the sling procedure is a good decision but with more pad changes and heavy incontinence the AUS is the choice procedure. I am not sure what invasive means. It is basically an outpatient surgical procedure with 90% or more positive results lasting 8 to 10 years

 

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Thanks for the positive feedback on the sling procedure. Will keep you posted if I can get the surgery.

 

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cpalmer,
I think you are on the right track by giving PT and exercises more attention. If you were making progress that is. Really in my opinion anything you can do to avoid additional procedures and let the body take care of itself is the best route. Unfortunately sometimes that doesn’t work out and procedures are necessary.

I am thirteen months out from surgery and cannot say that I am 100 percent continent but very close. I wear a pad when I go to bed but that’s all. (I do have a little stress incontinence when lifting something or bending twisting occasionally but just a little dribble). I am lazy with kegels or I would probably be better.

 

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@cpalmer3930, I’ve missed a lot here as of late due to some spine issues I’m dealing with AGAIN! I just had to comment when I saw your post, having spent 25+ years living in Lincoln Park & Wrigleyville, would “3930” put you just south of Irving Park?
I certainly understand your choice to bicycle around the city and many might not understand that it is a Lifestyle Choice to ride your bike around Chicago. Saved me countless hours sitting in traffic, while getting great cardio at the same time! LST my MASI road bike I lived on in San Diego, destroyed 2 wheels in 2 weeks trying to learn Chicago’s version of “Streets”! forcing me to ride my Gary Fisher Mountain bike everyday to Chicago Board of Trade & The Merc” etc. Nothing like riding down the lakefront as the sun rises to get your heart thumping, I used my bicycles & Harleys for 90+% of my transportation.
Just an FYI, when numerous Docs said I’d never walk again after a botched spine surgery in 2007,I have “TONS” of gratitude to the PT teams at Northwestern I walked out of there completely unassisted after an 8mo in/out patient rehab PT program. I had an entire team of spine & pain Docs, all outstanding! I’d give them more time to help you….
The Urological team is the only one that left me with grave concerns. I signed up for an experimental laser procedure to remove inflamed bladder cysts, that surgery took my bladder pain from a 2-3 to 11, apparently they burned a bunch of nerves in there they shouldn’t have, leaving me in such bad shape for over a year I could barely ride in a car as every bump was a high voltage cattle prod to my bladder. That was 20+ years back, but it still makes me nervous when a DR is too gung-ho about any procedure. AUS might be considered a minor surgery to some, but there are a lot of nerves down there (I did a bit of damage to that area myself riding with an indwelling catheter).
My advice would simply be to give their PT team a chance to help you, there are some amazing folks there. This will give you time to research as well as to see if you can avoid the AUS altogether. The AUS surgeons will still be there in 6 months or a year. Personally giving up riding, even now would be asking a LOT! Which they don’t seem to be factoring in too much in their eyes.
Best of luck, you can PM anytime, as long as it comes with a Vienna Beef sandwich Sweet/ Dipped, and a grilled polish w/ chopped onion, not grilled

 

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LST was LSS Long story short, I LUFF SPELCHECK!

 

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I have received amazing feedback today. Thank you all so much. Where else would this even be possible?

Sprung87: Yes, I'm on the corner of Irving Park and Pine Grove, just a few blocks west of the lake. I was in San Diego just a couple of years ago and rented a bike to ride all the way to the top of Point Loma, where the planes are at eye level! Flat San Diego is not. There's a reason they ride electic bicycles out there.

I was visiting relatives and was surprised to find they had upholstered furniture on their balcony. "What happens when it rains?" I asked. "It doesn't rain," they said.

 

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I’ve posted about the Afex System in other links which I’ve been using for 5 years…I have incontinence 24/7 nonstop leaking…I didn’t want to do the AUS or other invasive procedures so I use Afex…

I’m 77 and retired and can avoid some of the situations that can be embarrassing..and helps that contacts are a lot less because of COVID…

Here’s the link…good luck:

https://store.arcusmed.com/Afex-Male-Incontinence-System_c2.htm

 

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C...,
You might want to give our patent-pending aid a try, which has not yet been tested on a bike, but may perform equal or better than with feet on the ground. Unlike the clamps and straps, it's a flexible sleeve-like device that puts upward pressure on the urethra restricting flow. It can be worn all day and all night, if necessary. Since it's flexible, addressing the comfort issue, it allows some leakage under stress conditions, which may or may not include cycling. We still welcome input from our testing volunteers, whom you would be joining. Info is available if you send me a note at amhelp@comcast.net Fynlee

 

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Can you give some more info on your device for incontinence...

 

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The devise is the MS800.