Some folks here have had the artificial sphincter installed. They'll
probably respond.

Meanwhile, Google AMS 800.

Regards,

Steve J

Hey, Charlie!  It's been almost two years.  How's your PSA?

Hi Charlie:
  I had the AMS 800 implanted in September last year after two years
of incontinence.  I was filling up a Depends Guard every 2-3 hours, so
6 pads a day sounds more or less like my experience.  I did not leak
much at night, but I sleep on my back and sides and that does seem to
make a difference.
  The surgery was no big deal.  I had some discomfort at the site of
the incision for the resevoir that lasted a week or ten days.  My
biggest problem was that the scrotum was tender for about five months.
One other man here told me the same thing, but we are the only ones
that had that compalint, so this is not the normal experience.  You
should be back to normal within a shorter time.
  My doctor told me that about one third of his patients do not wear a
pad at all.  He expalined that they can only make the "cuff", the thing
that clamps off the urethra, so tight or else it would cut off the
blood supply.  So you will probably still have some leakage when
lifting, sneezing, etc.  But most guys use a panty liner type pad, not
the big pads like the Depends Guards, and they only use one per day.
So figure this will be a big improvement.  Do not go in expecting to
come out back to "normal".  And, of course, you have to learn to work
the pump in order to urinate.  That takes some getting used to but is
not big deal.
  Now, in the interest of full disclosure, I have to be honest and
tell you that my experience has not been totally satisfactory.  I still
leak a lot more than what is normal for men with the device.  I use 2-3
Depends Guards per day.  My doctor told me that if he had a smaller
cuff he would have used it, but what he used is the smallest they make.
So I still leak more than what is normal.  I would still have the
surgery though.  My leakage is manageable, especially with the Depends
Guards which work great for me.  And 2-3 pads per day is a lot
different from filling one up every 2-3 hours!  So, you may come out of
the surgery never needing to wear a pad again, or you could end up like
me.  But either way you are better off.
  I hope others that have the device will comment.  Oh.  Remember that
this thing will not last forever.  They told me to figure ten years.
Of course, in ten years there may be a better treatment available.
  Good luck to you.  Feel free to contact me directly
friendofcurtis@yahoo.com if you want.  we can also talk on the phone if
you care to.

David S.

Charlie,

Like you I was using 5 or 6 pads a day (saturated). After 10 months of
this with no improvement in sight I decided to have an artificial
urinary sphincter (AUS) installed. I was warned that it might not make
me 100% dry but it would certainly be an improvement.

The surgery wasn't bad at all. No bowel prep was required. I only had
to take an antibiotic pill. They shaved me in the operating room after
I was asleep.  I went to the hospital one morning, was out of surgery
in about 1 1/2 hours, was up walking later that day and went home the
next day. There was more pain than I anticipated but that was easily
controlled with Vicodin at home.  I continued to be sore where the cuff
was installed, on the underside of the scrotum, for a couple of months.

The surgeon decided to put the pump on the right side of the right
testicle just under the skin because I'm right handed and he wanted to
make it as convenient to reach as possible. He made a very small
incision at the top of the scrotum, right side, to make the connections
to the pump. He also made an incision on the right side of the abdomen
several inches higher to install the reservoir.

He suggested that I take a very hot bath for 20 minutes once a day
during the first 2 weeks. That was really helpful to speed healing and
greatly reduced the pain.

After a couple of check up visits the surgeon activated the AUS. He
left it activated for a few weeks and then showed me how to deactivate
it at night. He said that I only have to deactivate it 2 or 3 times a
week. This is prevent damage (erosion) to the urethra.

I've found that if my bladder gets a little full and I sit down
quickly, squat, or lift something heavy, I leak several drops so I
still wear a pad, just in case, but I never come even close to
saturating it in a day.

Was the operation worthwhile and would I do it again? Absolutely. It
has greatly improved my quality of life.

By the way, the surgeon told me that if I decide to go ahead with a
penile implant, he will install a second cuff (that's two cuffs side by
side) during the same operation. He  says that should make me 100% dry.
I'm not ready to make that decision as I just started injection therapy
with Trimix and am having good results.

If you can think of any questions please post a message or email me
privately and I'll be glad to answer.

Best wishes,

Jim

Thanks for all the replies. My last PSA test was less than 0.004 -
that was 6 months ago. I'll get results of Monday's visit sometime
next week.

Charlie

Charlie, I had the AMS 800 installed almost 1 1/2 years ago. I had
increasing incontinence for several years after RP and RT and finally at 5-6
pads on a active day, and 1-2 on an inactive day spent at the desk, I had it
done. Now one thin pad is more than enough on any day. Some days I could
maybe go without one, but don't. A hard cough, certain types of physical
stress, bladder spasms, all may trigger a very light leakage. This I was
told was to be expected. If I really bear down, I could urinate very slowly
without using the pump, not that you would want to do that.

The only differences in my experiences, after reading other posts, is that I
was not told to deactivate the device at times to prevent erosion and I will
question this at my next Dr visit.  The discomfort after the surgery was not
bad, the scrotum was pretty tender for some number of months as it does take
some pressure to operate the pump. tender or not, you have to use it. Even
now it will get just a little sensitive from using the pump, but it's not an
issue.

The learning curve can be interesting, such as when you absently minded
stand there waiting for something to happen and then remember you need to
use the pump. Such as when you are heavily clothed and gotta gotta gotta go
and cannot get both hands in there to get things working (one hand for the
pump, one to aim and get beyond all those winter clothes). Such as when you
have one hand busy holding something else and you have to make things work
with just one hand. There have been a time or two when the guy behind me in
line at the urinal may have wondered about what I was doing as I groped
around!!

The device has made it possible to get back to a pretty much normal life in
a lot of ways. I do not suppose that it is for everyone, but it works for
me. Good luck to you, whichever way you go.

AMS 800 installed end of Dec '06. Days 3-10 lots of pain when moving
about, after that nothing. Doc says it will last the rest of my life
(56 Y.O.). Works great. Little leakage mainly caused by location of
cuff, and its external compression when I lean forward sitting (which I
try to avoid). A dream come true.

At 2 years, I'd agree there may be little improvement left. I would
agree
with the recommendation for the sphincter. It's made by American
Medical Systems
(AMS 800), and in general has excellent patient satisfaction. It may
not be perfect or get you 100% dry, but usually pretty close.

It is a complex implanted device with 3 main components: (1) a cuff
around the urethra, (2) a reservoir in the lower abdomen/groin area,
(3) a small pump in the scrotum, usually on the hand-dominant side. Due
to it's complexity, it does have a rate of complications or mechanical
failure. A simpler operation is the perineal male sling, but this
operation is probably more suited for men who have 1-3 pads per day
leakage.

I don't usually find urodynamics particularly useful before AMS800
surgery, unless you give some history of a lot of unstable/irritable
bladder symptoms.

Best wishes..

===
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