Spoke yesterday to the Physicians Assistant at the incontinence
specialist's office.  Had a very good conversation with this man.  He took a
lot of time to answer my questions and fully explain things.  The main
points were:

   You will probably still need to wear a pad.  One, the extent to which
the device clamps down on the urethra has to be limited otherwise it would
cause damage.  So it is not like a faucet that "completely" shuts off the
flow.  The main cause of leakage is that men do not wait for the device to
automatically reactivate before putting Willie back home.  It takes a full
minute for the valve to let the fluid back into the device to close off the
urethra, so there is often leakage during that time.  There is also leakage
just as we have now with stooping, lifting heavy objects, sneezing or
coughing hard, etc.  Expectations have to be reasonable.  Getting the device
does not mean completely getting away from pads, although some patients do
not use them any longer.  Of course, what is needed is the panty liner kind
of absorbent pad, not the large ones like I now use.  He said to expect a
80-90 percent improvement.

   Plan to be hurting for a week to ten days.  Sitting will be
uncomfortable until the bruising goes away.  In this case, being an office
worker is a liability.  I will need to take a week or more off work.  Use a
donut to help ease the discomfort of sitting.  Cannot drive for a week
either, for the same reason.  If on pain medication the driving may be put
off longer, but the week to ten days is the norm.

   No catheter is required unless there are other problems involved.  The
way he talked it sounded like that did not happen often and it really does
not have to do with the artificial sphincter surgery but rather other things
that the patient may have to have done at the same time.  No detail on what
he meant.

   The device has an on/off switch.  Last year he got calls twice from men
who had accidentally shut off the device and could not urinate.  He just
talked them through hitting the correct switch to turn it back on and then
they were fine.  Be aware of the these switches and learn how to use them.
In the middle of the night there is no one to call for help!

   The natural sphincter does not atrophy after placement of the device.
If for some reason the artificial sphincter has to be removed you do not
lose ground, but do go back to where you were before.  That one was
important to me.  This is not an irreversible step (the penile implant is).

   If it is necessary to change the position of the clamping mechanism
there could be an implication for the penile implant surgery.  The urethra
gets smaller the further away you get from the base of the bladder.  The
smallest clamp, tube, whatever they call it, may be too big if it is
necessary to place it further down the line.  In that case they take some
tissue from the penis to put around the urethra to make for a tighter fit.
That part could make placement of a penile implant difficult.  He did not
elaborate on the why of that, but just be aware and ask your doctor if this
could be an issue.  My wife is okay with the artificial sphincter, but she
is against the penile implant (keep me away from all the widows in the
neighborhood???).

   That covers it I think.  I will contact the insurance company to confirm
that they will pay for this surgery (and ask about the penile implant too).
The doctor that I am seeing has done over a thousand of these artificial
sphincter surgeries, so I feel confident that he knows what he is doing.  I
would not go to just anyone for something like this.

   Thank you.  Good luck if you decide to proceed in this direction, and
please report your experience here for the benefit of others facing this
decision.

David S.  (card carrying member of the leakers club).