HealingWell
Search Close Search
☰

Advance sling surgery issues

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/25/2011 4:16 PM (GMT -5)
I had advance sling surgery on July 29. On July 30 I was unable to urinate and despite weekly attempts to remove the catheter it is still there on September 25. Surgeon ways this has never happened before and says maybe the sling is "too tight". Originally he spoke of "adjusting" it but it now sounds as if that means disconnecting it. In others complete failure and back to where I was four years ago after the radical prostetectomy in March 2007. I had radiation in September 2010 and have 0 PSA.

I have an appointment with the surgeon on Sept. 28 to try and get information from him about what he plans to do and what I should expect. No date for the surgery as yet. This has been extremely stressful and uncomfortable. I normally exercise by cycling and swimming with a Masters Club and so have been unable to do these thing for two months. which is not good for general health.

I am very confused a to why the sling has not worked and what the result will be if it is disconnected.

(added thread title)

Post Edited By Moderator (Steve n Dallas) : 9/26/2011 3:12:05 AM (GMT-6)

Posted 9/26/2011 8:19 AM (GMT -5)
Dear en-US, 734

Sorry to read about your difficulties.

Approximately two years ago I was implanted with a Virtue sling and it was a total disaster. It was partially removed before being implanted with an AdVance sling. The AdVance sling has been fantastic.

I used Dr. Angermeier at the Cleveland Clinic for the re-do because he specializes in sling surgeries that have resulted in bad outcomes like mine.

Regarding slings, he only implants the AdVance sling and enjoys a good history with this device.

He could be a good source for a second opinion before you agree to have your sling surgery reversed.

Feel free to email me if I can be helpful.

Best wishes,

John

Post Edited (male_sling_problems) : 9/26/2011 9:54:04 AM (GMT-6)

Posted 9/26/2011 9:05 AM (GMT -5)
I am in Toronto and my surgeon is at Sunnybroook Hospital. My surgeon has an excellent reputation but seems puzzled by the failure of the surgery and I have the impression he thinks there is only one thing to do - disconnect. I would be interested in knowing more. My problem is I am unable to fully empty the bladder once the catheter is removed which results in stress and pain.
Posted 9/26/2011 10:17 AM (GMT -5)
Dear en-US, 734,

From Toronto you can drive to the Cleveland Clinic in approximately 4-5 hours going through Buffalo and crossing the Rainbow bridge. I believe a passport is required to cross the border now.

A doctor's referral is not required to make an appointment at the Cleveland Clinic. You can call and make your own appointment.

Regarding undoing your AdVance surgery, it is my understanding that a surgeon would make a small incision behind the scrotum and "snip" the mesh under the urethra. This "snip" allows the bladder and urethra to drop to its pre-sling surgery location.

You could also consider contacting American Medical Systems directly to learn if they have any suggestions.

It is my understanding that tens of thousands of individuals have been helped or cured by the AdVance sling. I hope you can find solutions and join this group.

Best wishes,

John
Posted 9/26/2011 10:59 AM (GMT -5)
Thank you John. You have given me something to think about.
Daniel
Posted 9/26/2011 11:43 AM (GMT -5)
Daniel,
I too have the AdVance sling. I had mine installed by Dr Mayer, University of Rochester Urology. Before he did the installation, I asked him how he defined "Zero leak". He said about 5-10 ml per day. I told him I defined "Zero" as "Zero", "zilch", "nada". He told me he could make it tight but there would be some trade-offs. When they removed the catheter I retained about 100 ml and went through the night without peeing. Awful pain. I ended up back in his office being catheterized to let it all out. I don't know how you spell "relief" but I spell it "F-o-l-e-y". I had the new catheter in a for a few more days and everything has been fine since then.
The AdVance works by having the tissue grow into and over it. After 6 weeks you cannot take it out. The "removal" consists of snipping the sling portion and leaving the mounting behind.
Now it takes me 2.5 minutes to pee but I am dry. Well worth the inconvenience.
Good luck to you.
Jeff
Posted 9/26/2011 12:54 PM (GMT -5)
I have the catheter out and re-installed 7 times. The longest was the second time about 14 hours which meant a taxi to emergency at 5 am.
Your comment about tissue growth was helped me to realize that after two months the sling must be healed into place.
Thanks for your response
Daniel
Posted 10/1/2011 4:04 AM (GMT -5)

en-US 734,

Sorry to hear about the problems you are having.

A drawback of the AdVance sling is that, once implanted, it cannot be adjusted.  Therefore the patient is completely dependent on the surgeon getting the tension correct first time.

My surgeon has just told me of a recent (2010) development in sling technology from Austria, the A.M.I. ATOMS system. 

Instead of the mesh support, a small silicone "cushion" applies the requisite pressure.  The cushon can be inflated/deflated at any time after surgery by inserting/withdrawing fluid via a small port that sits under the abdominal skin. 

An explanation from the manufaturer is at http://www.ami.at/en/index.php4?m1id=2&m2id=69&m3id=228 and an animated film is at http://youtu.be/88SAcOkL-iA. 

The only clinical results I have been able to find so far are at http://registration.akm.ch/einsicht.php?XNABSTRACT_id=121191&XNSPRACHE_id=1&XNKONGRESS_id=130&XNMASKEN_id=900.  The sample size (7 patients) looks a bit too small to be anything other than an indication. 

I'd been considering the AdVance sling, but I'll certainly be giving this alternative some serious thought.

BTW I once had a complete blockage of the urethra and it's an experience nobody ever forgets - those three hours were the longest year of my life! 

As a result I sought out a Continence nurse and got her to teach me how to self-catheterize.  It's surprisingly easy and painless to do. 

Now I never travel without a catheter discreetly stowed in my toilet bag.  I've never had to use it, but it's wonderfully comforting to know it's there if needed.

Posted 10/1/2011 7:31 AM (GMT -5)
Sorry to hear your problems. I have a Virtue sling that did not help. Better news is that I went for an AUS a year later and it works great. The slimg is still there alomg with the AUS. You still have a great option to fis your leakage.
Posted 10/1/2011 8:49 AM (GMT -5)
On Wednesday, Sept 28 there was a glimmer of hope in that the bladder emptied when catheter was removed but it was too late in the day to be sure and not wanting to risk a return to emergency the catheter was re-inserted. Surgery for this week was cancelled. I am going early on Monday for a proper test. I am afraid to be too hopeful but definitely fingers crossed.

Recent comments appreciated especially about being prepared to self-catheterize. My trip to emergency remains a vivid memory.
Posted 10/1/2011 10:14 AM (GMT -5)

Here's a link to a larger clinical trial (99 patients) of the adjustable ATOMS system 

      http://www.uroweb.org/events/abstracts-online/?id=108&no_cache=1&Aid=31316.

OR  http://www.postersessiononline.com/173580348_eu/congresos/26eau/aula/-P_989_26eau.pdf

And here's a link to a detailed description of the implantation procedure by it's originator, Dr Wilhelm Bauer http://www.pelviperineology.org/march_2011/pdf/adjustable_transobturator_male_system.pdf

Of particular interest is that it can be, and has been, used where other systems have failed (including the AdVance sling, without removal of the original). 

It may be that Dr Bauer is coming to my part of the world next month.  I hope to get the opportunity, through my surgeon, to question him further.  Perhaps even to have him participate in the operation, should I decide to go ahead! 

Post Edited (EverOptimist) : 10/4/2011 11:44:02 PM (GMT-6)

Posted 10/3/2011 10:33 AM (GMT -5)
en-us, In my opinion, you should learn how to do self catheterization. It's not difficult.

The uro that did my AdVance sling was an advocate of making it as tight as possible. While I had retention problems for a few weeks, that went away, and now I'm dry, dry, dry (have been since the procedure, 3 years ago)

I do find that it's easier to empty out if I'm standing, and it also helps to push up behind the scrotum. My theory (but I'm a computer geek, not a doctor) is that doing so helps bread the mucosal seal in the urethra.
✚ New Topic ✚ Reply