Inflatable artificial sphincter

Description

You will have either general anesthesia or spinal anesthesia before the procedure. With general anesthesia, you will be asleep and will not feel pain. With spinal anesthesia, you will be awake but numb from the waist down, and you will not feel pain.

An artificial sphincter has three parts:

• A cuff, which fits around your urethra, the tube that carries urine from your bladder to the outside of your body. When it is inflated (full), the cuff closes off your urethra to stop urine flow or leakage.
• A balloon, which is placed under your belly muscles. It holds the same liquid as the cuff.
• A pump, which is placed in a man's scrotum, or underneath the skin in a woman's lower belly or leg. The pump inflates the cuff.

A surgical cut will be made in one of these areas so that the cuff can be put in place:

• Scrotum (men)
• Labia (women)
• Lower belly (men and women)

Once the artificial sphincter is in place, you will use the pump to empty (deflate) the cuff. Squeezing the pump moves fluid from the cuff to the balloon. When the cuff is empty, your urethra opens so that you can urinate. The cuff will re-inflate on its own in 90 seconds.

Why the Procedure is Performed

Artificial sphincter surgery is done to treat stress incontinence, a leakage of urine that occurs with activities such as walking, lifting, exercising, or even coughing or sneezing.

The procedure is recommended for men who have urine leakage after prostate surgery.

Women who have urine leakage usually try other treatment options before having an artificial sphincter placed.

Most of the time, your doctor will recommend drugs and bladder retraining before surgery.

Risks

This procedure is generally safe. Ask your doctor about these possible complications.

Risks for any surgery are:

• Infection at the site of the surgical cut
• Opening of the surgical cut site
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Other infection

Risks for this surgery may include:

• Damage to the urethra, bladder, or vagina
• Difficulty emptying your bladder, which may require a catheter
• Urine leakage that may get worse
• Failure, infection, or wearing away of the device that requires surgery to remove it

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, including over-the-counter medications, herbs and supplements that you buy without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

Your doctor will test your urine to make sure you do not have a urinary infection before starting your surgery.

After the Procedure

You may return from surgery with a catheter in place. This catheter will drain urine from your bladder for a little while. It will be removed before you leave the hospital.

You will not use the artificial sphincter for a while after surgery. This means you will still have urine leakage. Your body tissues need this time to heal.

About 6 weeks after surgery, you will be taught how to use your pump to inflate your artificial sphincter.

You will need to carry a wallet card or wear medical identification that tells health care providers you have an artificial sphincter. The artificial sphincter must be turned off if you need to have a urinary catheter placed.

Women may need to change how they do some activities (such as bicycle riding), since the pump is placed in the labia.

Outlook (Prognosis)

Urinary leakage decreases for many people who have this procedure, but you may still have some leakage. Over time, some or all of the leakage may come back.

There may be a slow wearing away of the urethra tissue under the cuff. This tissue may become spongy. This may make the device less effective. If your incontinence comes back, changes may be made to the device to correct it.

Alternative Names

Artificial sphincter (AUS) - urinary

References

Staskin DR, Comiter CV. Surgical procedures for sphincteric incontinence in the male: artificial genitourinary sphincter and perineal sling. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 78.

Adams MC, Joseph DB. Urinary tract reconstruction in children. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 129.

Update Date: 6/18/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.