13 March 2012

Posted by DMC on 14 March 2012 in Diary |

I had a bit of a shock yesterday when I thought that my artificial urinary sphincter (AUS) had finally gone wrong. I should perhaps explain, for those readers who were not with me in the earlier days when I recounted the history behind the AUS.

What happened is this. In 2000 I misdiagnosed with prostate cancer. I discussed the various treatments with my urologist and we agreed on a radical prostatectomy operation. Following this operation I was almost 100% incontinent but by dint of daily exercises I managed, over several months, to get this back to 95% continent and was able to dispense with the horrible leg bags (and bed bags) which I had to have strapped to me to collect my urine through a catheter inserted in my willy. My urologist was so pleased with me that he suggested that we with one more operation he could probably clear up the last 5%. Accordingly I submitted myself to what he described as a bio plastique insert to the urinary sphincter.

To cut a long story short, that operation did not work and, in fact, had the adverse effect and I was once more 100% incontinent. I was referred to an urologist in Harley Street who in turn referred me to Prof Mundy, at London Bridge Hospital, who some weeks later, carried out an operation to insert an AUS. Mundy was acknowledged as one of the leading surgeons who carried out this particular operation and, in my case, it went without mishap. The resultant effects was that I no longer had any external devices but could pee, ostensibly like everyone else, except in my case it meant grasping a small pump in my scrotum and with the other hand squeezing the end of it to allow the bladder to be evacuated. It was a very clever device that as I peed, a little reservoir filled up and when the bladder was empty would shut off the flow down the urethra.

This worked wonderfully well for several months and I felt like normal person again. That is until I managed somehow to damage this piece of equipment. It came about because pre-empting the day when my hands would not allow me to operate it, I designed a battery driven device, strapped onto my thigh, that would do the squeezing for me. I spent the day with technicians at Addenbrookes Hospital trying various alternatives and I believe it was during one of these sessions that I knocked out this equipment..

When I got home the evening after spending the day at Addenbrookes I told ‘my lovely’ that I thought I had ruined the device and now it was permanently open, in which case it would have the same affect as me being 100% incontinent. As a precaution that night I slept in a sort of nappy for adults, having protected the bedding by placing a rubber sheet under the cotton one.

I was amazed the following morning to discover that I was completely dry and was able to empty my bladder like any other man but as a precaution I wore a pad all day expecting to leak but to my delight I got through that day, and the following night, perfectly dry. I have been so ever since and been able to pee as if I had nothing wrong with me. It has changed my life.

In the post-mortem which followed the consensus of opinion was that I had somehow managed to jam open the valve, which allowed the flow from the bladder, you

That must have been at least three/four years ago and I have come to take it for granted but live with the fear in the background that one day the valve would move either to the completely shut position, or completely open. Either way with a miserable prognosis. If it was completely shut it would not be until my bladder was full that I would realise that it was no longer working and would have to be rushed to hospital to have a catheter inserted in order to empty the bladder. From then on, as it would still be impossible for me to operate the device myself I would need someone to help me every time I needed to have a pee – and I cannot imagine anyone else being able (all willing!) to grasp my scrotum and operate the pump for me, after all there is a limit to friendship! alternatively to revert to leg bags. If it was completely open it would mean back to a catheter and leg bags . It is bad enough as it is relying on others to help me without adding the horror of leg and bed bags..

Back to the fright I had yesterday. My carers come in at midday and six o’clock. As I can only last those six hours without a pee, with some discomfort, ‘my lovely’ has always insisted that I empty my bladder, as best I can, around four o’clock. Yesterday, although I felt the urgency, when it came to it, I sat with the bottle in place for at least 15 min, without being able to pass a single drop of urine. I panicked somewhat, convinced that the dreaded day had come at last when the device would have moved from its half open stuck position. In the event, I’m happy to say, that when the six o’clock nurse arrived, I peed as normal. So the panic was over but the fear always remains.

I only recount this rather personal experience in case there are other patients out there with an AUS and no use of their hands. Of course, it’s quite possible, that I’m the only one!

The good Dr arrived back in Australia to be met by son Tom, who was in the best of spirits, so we can only hope that it was a scare that came to nothing, although it is possible, that the results of various tests and still not come through.

 Click here to see some repartee worthy of and Australian Oscar Wilde. Frankly, I cannot recall having met anyone male-female, during my five years there then demonstrated such wit.

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