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ARTIFICIAL URINARY SPHINCTER
What is an artificial urinary sphincter?
It is a device made of silicone rubber that has three components:
- An inflatable cuff, which can open and close, that fits around the urethra.
- A pressure-regulating balloon that controls the pressure which is transmitted to the cuff.
- A pump to control inflation and deflation of the cuff.
Surgery Overview
The cuff is placed around the urethra, usually a few centimeters below the bladder. The balloon is placed within the pelvic space and the pump is placed in the scrotum in a male or the external labia in a female. The cuff fills with fluid from the pressurized balloon causing it to co apt and provides continence. When one wants to void the pump is compressed and fluid is pumped from the cuff to the balloon reservoir. The pressurized balloon will cause the cuff to close within 60-90 seconds giving the patient time to void completely.
Preparation for Surgery
Artificial sphincters are implanted in people with complete loss of urinary control. This may be the result of:
- Surgically induced incontinence.
- Neurologic mediated incontinence.
- Incontinence resulting from other failed procedures.
Preoperative evaluation is critical. Urodynamics are done to evaluate for adequate bladder capacity and hyperactivity as well as its ability to empty. Cystoscopy may be necessary in patients who have had prior radiation or surgery of the prostate or bladder neck. Sterile urine must be documented in all patients, and anyone with a history of a urinary infection must be treated with appropriate medication.
The Procedure
Patients will receive broad spectrum antibiotics preoperatively. A general or spinal anesthetic is administered. Two types of incisions are made in males, one in the perineum behind the scrotum or on the front of the scrotum. In women just a lower abdominal incision is needed. The cuff is first placed around the urethra. Next the balloon is placed in the lower abdomen. Finally, these are connected to the pump, which is placed in the scrotum or labia. The device is tested, and then deactivated. A small catheter is inserted through the urethra at the end of the operation and left in overnight. Typically the procedure takes 90-120 minutes.
Postoperative Care
Patients will be admitted overnight to be observed for bleeding and to receive intravenous antibiotics. The catheter is removed on the following morning and the patient should expect to remain incontinent for 6 weeks until the sphincter is activated.
After discharge the patient should limit their activity, including no driving for the first 2 weeks, however daily walks are strongly encouraged to prevent blood clot formation. Instructions are given to call immediately if a fever, swelling, or redness of the operative site develops. The patient is usually seen 3 weeks post op and then at 6 weeks at which time the device will be activated.
Risks and Complications
Complications are not common with greater than 90% of the devices working at 5 years after surgery. The risk of infection is greatest in the first few weeks and would require removal of the device. The long term risk of urethral erosion from cuff pressure on the urethra is rare but also would require removal of the device.
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