What is an Artificial Sphincter?
Although urinary incontinence is not a life-threatening situation, it certainly affects lifestyle. For many it means wearing damp undergarments, diapers, having skin irritation or diaper rash. It may limit his or her physical activity, social relationships, sexual attitudes, and ability to do spontaneous activities without careful planning.
Medical therapies including medications, exercise programs, and biofeedback techniques have helped many of these patients. However, there remains a group of patients who still have leakage of urine to such a severe degree that something more than the above treatments must be done. For these people, surgical implantation of an artificial urinary sphincter may be a winning solution. Patients who have achieved success with an artificial sphincter include men who have had surgery on their prostate and have tried multiple drugs and devices with no success.
Before this device is implanted the patient must obviously have severe symptoms and have failed all other drug, biofeedback, and other surgical approaches. Their bladder must be large enough so that it can hold enough urine in-between urinating. The bladder has to be neurologically intact, not contracting on a regular basis and causing high bladder pressures, urgency, and a need for frequent urination. The bladder must also be infection free and prior to the implant the patient must be able to empty the bladder completely. If these criteria are met then the patient may be a candidate for the implantation of the artificial sphincter.
How Well It Works
Most people treated with an artificial sphincter regained continence or had a significant improvement in their ability to stay dry. In one study, artificial sphincters were working properly 5 years after surgery in 90% of the study group. With time there may be a gradual wear of the tissue under the cuff of the sphincter, which may lead to a decrease in the effectiveness of the device.
An artificial sphincter is a device made of a plastic material that has:
- An inflatable cuff that fits around the urethra close to the point where it joins the bladder.
- A reservoir that holds the water when the cuff is deflated located above the pubic bone.
- A pump to control inflation and deflation of the cuff located in the scrotum.
In men the procedure can be done through a very simple 2-3 inch cut in the scrotum or between the scrotum and rectum. After entering the pelvis the about 1½ to 2 inches of the urethra is located and is separated off the surrounding structures.
A donut-like cuff is then placed around the urethra close to where it comes out of the bladder. This cuff is then attached to a pump mechanism that is placed in males in the scrotum next to the testicles. The pump is then attached to a small reservoir holding 25 cc (about 2½ tablespoons) of salt water that is placed behind and above the pubic bone. This reservoir pushes fluid into the donut cuff around the urethra (male) compressing these structures and acting as an artificial sphincter or valve.
As the bladder fills and the patient develops an urge to urinate he/she squeezes the pump two or three times pushing the 1.5 to 2 cc fluid that is compressing the urethra in the donut cuff back into the reservoir giving the patient has 2½ to 3 minutes to urinate before the cuff automatically refills giving urinary control until the next need to urinate.
This procedure can be done by urological surgeons experienced in this technique in about one hour and normally requires a 24 hour hospital stay.
After surgery the device is made nonfunctional by pressing a small valve or button on the top of the pump in the scrotum or labia. This is done to allow the urethra or the bladder neck to heal, improve its blood supply. Many surgeons advise their patients to deactivate the device each night since most incontinent men or women are continent in the reclining sleeping position. In the morning the device can be activated and functioning during the daily activities. This is done in an effort to give the urethra or bladder a "rest" from the pressure of the cuff and reduce the wear on that tissue. The patient is also instructed to empty the bladder on a schedule to prevent dangerous over filling of the bladder.
If you have one of these devices implanted you should consider carrying a medical identification card to notify health care providers that you have an artificial sphincter. The sphincter must be deactivated whenever urinary catherization is performed.
After this device is implanted you should be very careful to watch for signs of infection, including urinary frequency, pain, or burning with urination, fever, leakage of urine, or bleeding.
What To Expect After Surgery
Most patients stay in the hospital at least over night and oral antibiotics are usually prescribed for 1-2 weeks following the surgery. Activity may be restricted for a couple of weeks and the person is advised to avoid sexual activity until the device is activated.
After surgery the device is deactivated and remains that way for six to eight weeks to allow healing. The Urologist may Cystoscope (look through the urethra into the bladder with a scope) the patient to be sure that the urethra is well healed, that there are no tears in the urethra, and that the donut cuff is not visible inside the urethra.
Complications with artificial sphincter procedure are: failure of the implant to function properly, infection, and erosion of the device through the tissue in the area of sphincter placement.
What To Think About
It is generally reserved for people for whom other treatment options have failed.
Artificial sphincter treatment is more successful in men than in women and is not usually considered until all other treatment methods have been tried and failed.
Before having surgery for urinary incontinence, talk to your doctor about the following:
How much success has your doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.