Severe incontinence has a devastating impact upon quality of life. One treatment, the artificial urinary sphincter (AUS) is producing excellent results.

Artificial Urinary Sphincter Patient David Abel
David Abel founded a renowned automotive design company

BPC patient David Abel, aged 62, describes how having an AUS fitted has changed his life.

“I was diagnosed with prostate cancer in 2009. We knew the cancer had spread into some lymph nodes and I was warned that if prostate cancer is understood as “tigers” and “pussycats,” I had got the tiger. My PSA was 23.1 and I had a Gleason score of nine. So it was a case of belts and braces to tackle what was a very aggressive form of prostate cancer.

It was touch and go whether I would be able to have surgery. I was under the care of the Birmingham Prostate Clinic and was able to have a specialist procedure called extended lymph node dissection: 23 lymph nodes were removed. Because my PSA started to rise after surgery, I then had to have radiotherapy and two years of hormone treatment to provide the best chance of clearing all the cancer. I always knew Alan Doherty and all the specialists at BPC had my best interests at heart.

I believe it was the radiotherapy which damaged my bladder. Without any warning, my bladder would empty – I had no control and over time, things didn’t really get any better. I did my pelvic floor exercises, but that made no difference and you find it takes over your life. I wouldn’t leave the house without a bag of spare pads and everywhere I went, the first thing I did was find the toilets; I could tell you where every single toilet is in the supermarket, pub and everywhere I went. Drinking pints of beer with my friends was out of the question.

Mr Doherty referred me to his colleague Mohammed Belal as he specialises in the treatment of incontinence. At first we considered a male sling, but I had a urodynamic assessment and Mr Belal advised me that my incontinence was at the severe end of the spectrum and therefore a sling was unlikely to work. He suggested I had an artificial urinary sphincter implanted.

Of course, I did feel a little apprehensive about it, although my main apprehension was that it may not work. Mr Belal had explained that there was no guarantee it would be 100 per cent successful. But after six years of severe incontinence, I was certainly prepared to try something that we hoped would make things better.

I had my operation in September 2015. The operation itself was not a big deal – I remember being a little sore afterwards but no more than that. Everything is implanted internally and I remember I couldn’t particularly feel it there and certainly there wasn’t any pain from it. You wait for six weeks before it is activated so that all swelling from the operation can settle down.

After that, I came into the clinic for the AUS to be activated. I drank plenty of water, as instructed, then went to the toilet. I was able to pass water without any problems and from that moment, it worked brilliantly, without any problems whatsoever.

The AUS is made of three parts: there is a cuff, a pump and a balloon. The cuff is implanted around your urethra (the tube that connects the bladder to the outside of the body) and is filled with fluid which acts like a cushion, stopping urine from leaking out.

When you need to pass urine, you squeeze the pump, which is located inside the scrotum and this makes the fluid drain from the cuff into the storage balloon, allowing the urine to flow out of your body. After that, the fluid automatically flows back into the cuff, protecting you from leaks.

It works brilliantly for me. I’ve gone back to the gym and have started cycling again. During the last six years, I’ve felt very tired and weak and have lost my fitness. It is a battle to get it back again, but I’m doing my best, taking it one step at a time.

I’m looking forward to going on holiday and being able to go into the pool for the first time in six years. I can enjoy a pint with my friends again and I feel confident enough to wear something other than black trousers, which is all I was able to wear. Very occasionally, if I cough I might dribble a small amount, but that is completely different to walking around with my jacket stuffed full of incontinence pads, knowing I’d need all of them to get through the day.

It has been a very tough and of course it has had a huge impact on my life and my whole family. But I am grateful to be alive and to be there for my wife, my children and and my two grandchildren. I have friends who have died from prostate cancer, so although it has been very hard, I do feel fortunate.

For the first time, my diary is not full of hospital appointments. We have spent many days on our nerves’ edge waiting for the results of tests and feeling desperate about the effect of incontinence. But now I’ve been off hormone treatment for a year and am finally dry. My diary is now looking very different. I talk to other men a lot about prostate cancer and friends always call me for advice – I’m very open about it. I hope more men will hear about the artificial urinary sphincter because long term incontinence is desperate and this has really changed my life.”