Mets Day 292 - No artifical sphincter for me

Today I spoke with Dr. Greg Bales of the University of Chicago.  We had been trading calls for a couple of days.  He's the incontinence specialist who works with Gray Steinberg.  Dr. Bales was familiar with my history, and sympathized how nocturnal incontinence can be a real challenging problem, especially with neobladder patients. He said that having sleep disruption in the way that I have been suffering is relatively uncommon.  He said that most men with nocturnal incontinence may wake up but are able to go back to sleep and get adequate rest,unlike what I'v ebeen dealing with fo the past 7 months.  

We discussed my options.  To my surprise, he said that, because I am usually continent during the day, he does not think that I am a candidate for an artificial sphincter.  Those are usually for patients that have no control on all days.  My daytime continence suggests that my pelvic floor is acting as a sufficient sphincter.  The function of the sphincter can be assessed by the urodynamic assessment.  If the assessment shows that the sphincter isn’t working properly, then I may be a candidate for an artificial sphincter.  But because an artificial sphincter has its own complications and risks, and because I am dry during the day, based upon the information he has, he would not recommend doing the surgery. 

He recommends that I have a urodynamic assessment locally.  He does not agree with Mark Schoenberg that I have to go to Chicago to have this done.  He also recommended that I create another voiding diary, recording my intake and output.  I did one in June of 2012, and another in July of 2012, and so I know the drill. 

I asked him what my options there were, since he did not recommend an artificial sphincter.  He said that the most common thing is that patients just wear pads and deal with it.  But most patients are not like me, who wake up and can't go back to sleep when they leak.  He said that some patients try self-catheterizing each night (been there, done that); others try leaving the catheter in overnight (done that with Foleys); others have used condom catheters (tried that, hated it). For anything else, he said I should work with a urologist who specializes in male nocturnal incontinence.   He recommended a specialist associated with the University of Maryland, and offered to make the introduction.  Looks like I'll continue my search for a solution.  No easy fixes, I'm afraid.