You have elected to undergo an Advance sling for the treatment of your incontinence. The primary purpose of this sling is to significantly improve your incontinence. This information is aimed at helping you understand your surgery and what you can expect when you go home. Please keep this information as you may want to review it again after your surgery.
The advance sling works by elevating and supporting your urethra so that your own sphincter muscle can function properly. It works best in men whose own urinary sphincter muscle looks good (we determine this when we looked into your bladder with the telescope) but cannot work properly due to a loss of support after the prostate is removed. It does not work well in men whose sphincter is scarred.
In the ideal candidate (the sphincter muscle looks perfect) we have a 90% success rate. We define success as being 90% better than where you are right now. You may still have some leakage with strenuous activities, coughing, etc. The more scarred your sphincter muscle looks, the less success we have with the sling. Some men choose to try an Advance sling even if their sphincter muscle does not look good rather than go right to an artificial urinary sphincter.
If we do not achieve our goals with the sling we still have options. Some men are treated successfully with a second Advance sling while others are treated with an artificial urinary sphincter. You can safely have an artificial urinary sphincter, if needed, after an Advance sling.
You will come back to clinic before your surgery date for your pre-op visit. We will discuss your surgery, answer any questions you may have, and sign the operative consent form. Because some men have difficulty urinating immediately after the surgery due to some swelling, we may teach you how to catheterize yourself. You will be instructed on how to do this by our clinic nurses on your pre-operative day.
It is very important that you do not have a urinary tract infection at the time of surgery. We will check a urine culture at your pre-operative visit. Please ensure that before you have left the clinics on your pre-op day, you have given a urine specimen.
If you are under the care of a cardiologist, please bring any records on your cardiac work-up with you to this visit. Please bring your medications or an accurate list of your medications with you to this visit. The anesthesia team will tell you which medications to take before the surgery. We will also give you a list of medications that can interfere with blood clotting. Please notify your surgeon and anesthesia if you are taking any of these medications. These medications are usually stopped 10 days before the day of surgery (however, you may need to clear this with the doctor that prescribed the blood thinner). We will let you know when to restart these medications after surgery.
Be prepared to spend several hours in the clinics on your pre-op day. You may eat and drink on this day.
You will be notified about what time you need to arrive to the Ambulatory Surgery Center the day before your surgery.
If you live far away, you may want to arrive the day before surgery. If you are planning to do this, please be sure that we have an alternative number (i.e. cell phone) for where to reach you to be sure you know what time to arrive for surgery. We also recommend that you remain in the area the night after surgery.
The night before surgery
You cannot eat or drink anything after midnight on the night prior to your surgery. Take your morning medications as instructed by the anesthesia pre-op clinic.
The day of surgery
Arrive at the Surgical Center at the designated time. A family member/friend must accompany you to the surgery, stay the entire time while you are in surgery, and be able to drive you home afterwards. You will not be able to drive yourself home.
An Advance sling is performed through an incision in your perineum (the area between the back of your scrotum and your rectum) and two small incisions on the scrotum. It involves using two trocars (like darning needles) to help position the sling and elevate the urethra. The sling (a strip of mesh) is designed to elevate the urethra so that your own sphincter muscle can function properly. The surgery takes 30 to 45 minutes and can be done under spinal or general anesthesia. There are no stitches or bandages that have to be removed. All the stitches will dissolve on their own. We use skin glue to seal the small incisions on your scrotum. Please do not pick this off as it will dissolve on its own.
After surgery, you will go to the recovery room. We may ask you to try to urinate once you are fully recovered from your anesthesia or we may opt to keep a catheter in your bladder (a foley catheter) for a few days. We will give you more information on this in the recovery room.
It is important that you get up and walk around as soon as possible after surgery. Because the sling is not sewn into place, your body needs time to “grow” into the sling and make the attachment strong. You need to avoid lifting anything over 20 pounds for 3 to 4 weeks following surgery. We recommend avoiding strenuous activity as well as those activities that result in squatting or raising the legs. Use caution getting in/out of larger cars as we do not want you to raise your legs more than 90 degrees.
You should plan to be out of work for at least a week following surgery. Your ability to return to work after surgery depends on your work requirements. It is important that you follow the activity restrictions as mentioned above for 3 to 4 weeks following surgery.
You should not drive while you are taking pain medications. We recommend not driving for 7 days following surgery. You cannot drive if you are still taking narcotic pain medication or have limited mobility.
We will see you back in the urology clinic 6 weeks after surgery.
If you have any urgent questions or concerns, please call our office at (304) 388-1900.