Let me tell you about my intimate friends, Percy, Clarry and Bob. We have been together for nearly 3 years; together we have climbed mountains, visited distant shores and go to bed with my wife.
It all happened like this. Over four year ago I had a prostatectomy and in spite of lengthy physiotherapy remained moderately incontinent. Pads were bulky and annoying and very often were quite insufficient. In addition to the incontinence itself, the leakage of even a few drops would irritate the urethra and produce an overwhelming urge to urinate even though there was very little there. The time had come to seek an alternative approach in particular since maintaining physical activity was important to managing my cardiac condition.
While I was aware of artificial urinary sphincters (AUS), it was my GP who suggested that I should investigate them in more detail and put me in contact with one of his patients who had one. His very favourable experience and that of some others, together with some information from the internet and a discussion with one of my urologists all lead to a relatively easy decision. As with all surgery there are risks including the small risk that the implant might become infected and then have to be removed. There are some preliminary investigations to determine whether one is a suitable candidate for an AUS.
And so Percy, Clarry and Bob became part of me. Percy is the pump that is inside the scrotum, Clarry the cuff the fits around the urethra behind the scrotum and Bob is the pressure regulating bulb in the groin. The surgery to implant the AUS takes only a couple of hours with an incision under the scrotum and another in the groin. Almost no pain relief was necessary and the after effects of the surgery were minimal other than that I would put a prize bull to shame for a few days! The AUS was activated about 6 weeks after surgery to give everything time to heal, and was immediately effective. What bliss!
The AUS is easy to use but one really needs three hands! One hand to hold the body of the pump (it is about 30x20x10mm), one to squeeze the bulb and one to steer. To use the AUS one needs to get it all out and deep opening zips are important to prevent scratches to the sensitive skin. But no one has ever asked me why I am standing there squeezing myself! The AUS is not perfect and strong sneezes, stumbling or anything that presses on the cuff will cause leakage. Riding a bicycle or an elephant is probably not possible and some chairs are a problem. There is no sensation of having the AUS though one can feel the cuff just under the skin and obviously the pump in the scrotum.
How long will the AUS last? I hope for 5 years. The AUS could have a catastrophic failure such as a faulty valve, the saline in the AUS could slowly leak as the polymer used in its construction is slightly permeable, but also one's body changes with time and body muscles deteriorate with age. In time changes in the urethra and surrounding muscles and the loss of pressure within the AUS will result in it being less effective, and the stage may come when it needs to be replaced or some other approach adopted.
In my case the cost was covered by health insurance but probably the whole process costs $A12,000-15,000, mostly for the AUS itself. Given the excellent outcomes in retrospect I would have gladly paid all the costs.
There is a detailed article on the AUS at http://www.emedicine.com/med/topic3019.htm but it must be realised that medical practice varies between countries and overseas based information must be used carefully.
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