Incontinence Decisions

The two-year anniversary of my RRP is coming up in a few months and I have not achieved continence. I am anticipating a conversation with my uro about options at our next meeting in June.

I have been reading about the AMS Sling systems from their website. AMS has two types of mesh sling. Their InVance system has the mesh anchored by titanium screws in the pelvis. They say installation is about 20-30 minutes and recovery is relatively fast. The second system is called AdVance. The installation procedure is similar, but the mesh seems to be anchored by the growth of tissue surrounding it rather than with screws.

I assume the recovery time would be longer with the AdVance system and you would need to be much more careful during the first two weeks or so after installation.

For the last several months, I have been seeing a physiotherapist who has helped with the Kegels, but I would still never venture outside without a pad. I use one pad per day. My perception is that my nights are good, with not much leakage and it is much worse in the daytime. My problem is stress incontinence (SUI) and is worse later in the day, after about 3:00 PM. But it is the small things that seem to lead to the most leakage, for examples, bending slightly to wash my hands in the sink; vacuuming; reaching to pick up a book from a table; shopping at the grocery store, etc. The big stresses, such as lifting, sneezing, etc. I can anticipate and contract the muscles in advance.

In order to test my beliefs about leaks, I measured my day and night leakage for one month. The empirical results were not consistent with my perceptions. My average day leakage was 8.8 grams with standard deviation of 6.2 grams and my night leakage was 7.9 grams with standard deviation of 9.6 grams. So, my day and night leakage was just about the same, much to my surprise. The difference in variability is explained because I had several night leaks of zero and never any day leaks of zero.

So, my questions are for those who have had the sling installed, (or for those who decided not to have one installed) what was your decision process leading up to installation? What options did you consider? How much leakage were you experiencing that led you to make the decision to go for more surgery? Is any amount of leakage tolerable? How ‘restricting’ is your lifestyle if you require one pad per day? If you had surgery, what was your outcome? Would you do it again?

Thanks for comments.

I elected to have sling surgery to cure my ongoing leakage after 2 1/2 years of 2-4 pads a day. I leaked mostly when walking and bending or standing up. I hated the pads and the urine smell. I researched slings on the web and determined the Advance sling was perhaps a bit less problematic since it had no screws into bone that the Invance used. The surgeon I chose also recommended the Advance sling and he had done a couple hundred prior to me with what he termed as 70% successful (dry to almost dry)

I had the surgery in late Nov 2012, had some leakage with urgency at the beginning but have not leaked a drop since mid Dec, doesn't matter if I bend, squat or lift...I do not leak. My sling was installed a bit on the tight side so I need to put a bit of upward pressure on my perinium area to pee but this is easily accomplished with a couple fingers and is unoticeable by others even when at a urinal. This procedure pretty much changed my life back to what it had been prior to any PCa surgery and I wouldn't change a thing.

The surgery entailed a very uncomfortable 3 weeks after surgery which included a catheter, bladder spasms, incision pain and general discomfort while seated and getting up and down. After 4 weeks I was fairly comfortable but incision pain did not go away until 8 weeks. I'm currently 3 months out of surgery and have never felt better, it's a real game changer for me and worth all the discomfort that I endured...I'd do it again without hesitation since my improvement in quality of life has been so significant. I can walk, run, leave without pads, never have to plan ahead or carry extras. You will likely be scheduled for a Urodynamics procedure prior to being recommended for this procedure.

If you have any more questions feel free to ask, there are others here that have had similar sling procedures and thier experiences helped me decide to follow through with this surgery. I'm just trying to help others in the same way they helped me.

Ron