Overview
An artificial urinary sphincter is an implanted device which compresses the patient’s urethra to keep it closed except when voiding. Severe stress incontinence can sometimes develop after prostate or pelvic surgery or secondary to damage to the nerves going to the muscles that control continence. It is indicated for patients with severe incontinence. An inflatable cuff fits around the urethra and prevents urine from leaking. When a man wants to urinate, he squeezes a pump placed inside the scrotum. The pump deflates the cuff, urine is released, and then the cuff automatically re-inflates. This type of incontinence surgery may be an option for men experiencing incontinence due to nerve damage or weakened sphincter muscles.
How It Works
The artificial urinary sphincter (AUS) is a hydraulic bio-compatible device with 3 components.
There is a fluid filled reservoir roughly the size of a golf ball that is implanted in the groin area next to the bladder. A pump device about the size and shape of the thumb is placed inside the scrotum in front of one of the testicles. The last piece is a circular inflatable cuff that is placed around the urethra and sphincter area.
When activated, the cuff compresses the urethra with sufficient pressure to withstand forces associated with most activities. When one has the usual sensation of a full bladder, the pump in the scrotum is pressed between the fingers twice to allow the cuff to open. Voiding is completed in the normal fashion and the device automatically closes over 1-2 minutes.
Patient EDU
This procedure can be done by urological surgeons experienced in this technique in about one hour and normally requires a 24 hour hospital stay and foley overnight.
Frequently Asked Questions
How well does It work?
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.
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 can I 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.
What should I think about when making a decision to have the surgery?
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.