I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

AUS - Consultants Differing Views

Email this conversation Print this conversation
User
Posted 11 Feb 2024 at 15:15

Suffering from incontinence since prostatectomy in Dec 2021 I’m keen to have an Artificial Urinary Sphincter (AUS) fitted asap. I was referred on the NHS 45 weeks ago and am still told it’s likely to be later this year before I have the procedure.

So, I’m exploring going Private and visited a top consultant last Friday as they say then can operate next month.

Let’s call my highly recommended NHS consultant 'A' and my also highly recommended private consultant 'Z'. A & Z had completely different views on some aspects of the treatment! I had radiation (brachy) in 2015 and had a prostatectomy when cancer returned in 2021. I also had a bladder neck (bulbous urethra) stenosis dilated in August last year. A brief summary of their opposing thoughts below:

Previous radiation treatment:

A: unlikely to cause any problems as the AUS is fitted further down the urethra from any infected area.

Z: 30% chance of urethral erosion. If this happens then several options inc. remove AUS and leave a catheter in and hope urethra recovers – then fit a transcorporal AUS.

Previous urethral stenosis:

A: continue to self catheter approx. once a week to prevent reoccurrence ........... even after fitting of AUS.

Z: Self catheterising after an AUS fitted could cause problems. Would want me to increase the length of time between self catheterization to 2 weeks, 3 weeks 4 weeks, 6 weeks etc and see if the stricture returns. Advises another cystoscopy, carried out by himself, to check the bladder neck (bulbous urethra) where the stricture was and examine the urethra for radiation damage.

So Z doesn't think A’s approach re. self catheterization is wise - so I now have another dilemma, which one is right? I only went to see Z to try and get the procedure earlier than I would on the NHS! Both highly regarded consultants in the field of AUS - two very different views!

Any thoughts?

Anyone else had previous radiation or urethra stenosis and gone on to have an AUS?

 

User
Posted 12 Feb 2024 at 00:57
My understanding was that catheterisation with an AUS is risky - I think something has to be put on your medical records so that A&E would know if you were admitted unconscious, for example.

Have you any indication of how much experience A has of fitting these slings?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 12 Feb 2024 at 07:56

Z lad, I had issues with a stricture and slow flow following surgery, I then also started loosing bladder capacity. I was also doing self catheterization. My PSA started to rise and the op was put on gold until after surgery.

The plan was to have urethral reconstruction followed by the fitting of the AUS. Unfortunately the salvage RT affected the bladder capacity and it was normal long a viable option. 

I was told there was only one surgeon in the country suitable to do the op. Under the rules of the forum I can't name but I am allowed to PM you his name.

Quite right about medics knowing about you have an AUS, they presumably would need to release the cuff or fit a suprapubic catheter.

Thanks Chris 

User
Posted 12 Feb 2024 at 16:09

Thank you Lyn for replying.

Inserting an indwelling catheter is not in itself a risky business if you have an AUS but the person who inserts it must be aware that you have an AUS. The AUS has to be deactivated before insertion and the healthcare professional needs to be aware of this. However, intermittent self-catheterisation is possible with an AUS, presumably one has to de-activate the devise oneself and then reactivate. Indeed I have read several papers which approve fitment of an AUS to folk who self-catheterise because of voiding issues.

Consultant A is the clinical lead for reconstructive surgery, male and female incontinence and paediatric and adolescent surgery for a NHS foundation trust. They also have some of the longest experience of current available surgeons re. fitting an AUS.

Consultant Z is a world-renowned Functional Urological Surgeon and Honorary Professor of Urology and is also director of the busiest urodynamics unit in the country. It's quite likely that atm they carry out more AUS procedures than any other UK surgeon.

User
Posted 12 Feb 2024 at 16:17

Hi Collickchris for replying.

Which op were you told there was only one person in the Country who could do it? Presumably not fitting an AUS or doing reconstructive surgery.

Thank you for PM'ing me.

 

 

User
Posted 12 Feb 2024 at 17:24

Originally Posted by: Online Community Member

Hi Collickchris for replying.

Which op were you told there was only one person in the Country who could do it? Presumably not fitting an AUS or doing reconstructive surgery.

Thank you for PM'ing me.

 

 

Z, I told by my second opinion urologist that Mr XX was the only guy to do the urethral reconstruction, because it was going to be done after salvage RT. 

Thanks Chris 

Edited by member 12 Feb 2024 at 21:33  | Reason: Not specified

 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK