My urologyst and urology related surgeon submitted me to a surgery leading toward an artificial sphincter. The surgery was about six (6) weeks ago and two (2) weeks ago the"system" was to be "opened up" to allow me to urinate when so sensed and needed to relieve the "pressure" by said accumultated urine through "controlled regular" urination. It appears that I was too anxious to "get back" to former "natural" urination and the initial attempts failed "big time". Today, another two (2) weeks later, I felt "ready" for the "big day". Unfortunately, even with the help and alltogether by the very surgeon(s) we did not succeed to "make the system work".... The lead to another postponement to "get the system working"....Are these kind of failures "common" and unavoidable? Everything that the surgeon and the head physician explained "made sense" to me. Special test of the urethra with "injection" of clear, steril water (and perhaps some possible medication, antibiotic or other ingredient(s)) ran OK but the "over-all" consensus was that " we need to repete these tests (and possible others?) in a week from now. That's where we stand today, in essence NO PROGRESS. Is such occurrence 'normal'? Any recommendation. I sure hate to have to go through these "torture" procedures, yet without a clear positive result. Any suggestion?Thank you, XXXXX XXXXX
Person's Gender: Male
Person's Age: 86 years, 87 by year-end
Since increased incontinence during the last 20+ years occurred, frequency of absorbend diper change got up to 4 to 6 times per 24 hour period. Thus the decision to have a surgical intervention. So far that failed and now I have a not working artificial sphincter in my urinary system.... What may the consequences be of such strange anatomical change?
Thanks for your question. If I don't respond to you immediately, it is because I am either in the OR or traveling. I WILL get back to you ASAP.Was the blockage that was opened, scar tissue at the bladder neck? Did you have your prostate removed in the past?Was the test you had done called urodynamics (to see if your bladder can still contract to get the urine out)?I assume that your main problem is that you cannot urinate at all (I think this is what you are alluding to in the post- correct me if I am wrong)
Please let me know when you got my questions above. I'll respond in the morning. Have a good night.
Whenever you are ready, I sure am anxious to hear from you. Any info that I missed transmitting to you? Cordially, Erwin.
I did not get any responses to the questions I had above. If you could answer them, I can provide you with better info. Thanks.Was the blockage that was opened, scar tissue at the bladder neck? Did you have your prostate removed in the past?Was the test you had done called urodynamics (to see if your bladder can still contract to get the urine out)?I assume that your main problem is that you cannot urinate at all (I think this is what you are alluding to in the post- correct me if I am wrong)
Hello Dr. Y: This is in response to your writing of today at 3:17PM. Sorry that I sort of missed that. I have been looking for some communication(s) from you. But here are the answers to your writing of 5/30/2012 at 3:17PM:
I am not sure what "blockage" you are refering to. Once my artificial sphincter was "reactivated" I continued not to be able to urinate. This, how I at least understand it, is and was NOT a "blockage" but "simply" a NOT "FUNCTIONING" (artificial) sphincter, i.e., as described before, eventhough I was able to press really hard as indicated by the surgeons and urologist the "ball"-like internal thumbsized anatomical part near the scrotum and "spreading" adhering soft tissue in front of it in order to "open up" the sphincter resulting in allowing the flow of urine through the penis which I wasn't able to achieve. And this after the surgeon and urologist "open up" the artificial sphincter in order to allow the urine to run through the urethra, just what the whole surgery was all ablout.... and not the drip, drip, drip of the urine "leakage".
There is no scar tissue at the bladder neck, so at least I am told.
As responded before, a urodynamics test (several over the past weeks) was made and "the baldder is functioning as expected".
YES, I continue NOT to be able to urinate, only continuous "leaking". And that now for the past over six (6) weeks (and more).
YES, I continue not to be able to urinate. Now, obviously, because the artificial sphincter is not in "operating" mode (or not "open").
I look forward to your response(s) and possible recommendation(s).
I shall be up again until late PM, around 11 PM or so.
Thank you, Erwin
OK. I think I understand your situation a little better. From what I gather, when you push down on the pump, you still cannot urinate. Is that correct?So are you leaking continuously through the urethra now since the sphincter has been placed? If not, ho ware you urinating?
Dear Dr. Y: Somehow I can't find copy of my answering your Tuesday May 29th 10:57PM inquiry and specifically so as to my prostate: YES I had it removed in 1992 with no malignancy and no further any problems there after. When responding to this question I also answered the query about blockage and urodynamics test.
I am curious what your recommendation(s) will be. I'm waiting for that! Thanks! Erwin
Now to your newest note: I hope I'm clear and sufficiently technical in medical lingo when describing my problems: Unless the pump is "in push down" condition (using your wording) (my urologist states "the pump is turned ON", I still dont know how he "turns on" the pump) I still cannot urinate. Thus the dripping. Just as before the pump was installed (and NOT turned ON) I was able to urinate but mostly leaked between actual "urinatings".
Also, YES I am severely leaking after the sphincter was installed but not placed into operation. So, in other words, despite the artificial sphincter installation BUT NOT TURNED ON, I still can't urinate "normally" withOUT significant leaking in between. We so far have not had the sphincter "ON" because I was not able to get it to work properly (squeezing some 1/2" thick piece of internal organ).
If your urodynamics test showed your bladder works fine, there is nothing more to do from an evaluation standpoint of your bladder.If the sphincter has not been activated yet (in the ON position), you will still have significant leaking of urine and won't urinate normally until you can function the pump properly. In your case, it sounds to me like your surgeon needs to spend more time with you and provide the model pump that AMS provides to show you what the pump should look and feel like so you can operate it successfully. This is the only way you will ever be able to urinate normally again.
Specializing in general urology and reconstructive urology
Dear Dr. Y and /or the "Just Answer Service":
Unfortunately I missed printing my last message to you before signing out couple of days ago. Would it be possible you to sent me a copy of said message I sent to Dr. Y? If needed, use my e-mail address XXXXX@XXXXXX.XXX . I would greatly appreciate receiving referenced copy of said message to "close" the case.
Again I certainly thank very much Dr. Y's efforts. Most cordially Erwin Rahn.
Is this the message you are looking for?If your urodynamics test showed your bladder works fine, there is nothing more to do from an evaluation standpoint of your bladder.If the sphincter has not been activated yet (in the ON position), you will still have significant leaking of urine and won't urinate normally until you can function the pump properly. In your case, it sounds to me like your surgeon needs to spend more time with you and provide the model pump that AMS provides to show you what the pump should look and feel like so you can operate it successfully. This is the only way you will ever be able to urinate normally again.