Definition An inflatable artificial sphincter is used to treat stress incontinence when the urinary sphincter isn't working well. It is implanted in the lower urinary tract to provide control of urine flow.
The inflatable artificial sphincter consists of three parts. These include:
a cuff that fits around the bladder neck
a balloon to control the pressure
a pump that inflates the cuff
The sphincter is compressed by the cuff. This cuff is inflated and deflated through a pump. This pump is placed in the scrotum of a man or the labia of a woman. Fluid to supply the system is kept in a reservoir implanted in the pelvis.
Who is a candidate for the procedure? This device is used only for people with complete or near complete loss of function of the urinary sphincter. This procedure may be performed to treat stress incontinence in men after prostate surgery, such as radical prostatectomy. It may also be performed in men and women with sphincter dysfunction due to spinal cord injury or multiple sclerosis.
This device is not used for urinary incontinence due to other causes. It is not used in people with very low volume bladders, and those with blockages of the urethra. This device is not suitable for those who have had extensive radiation therapy to the pelvis.
How is the procedure performed? In men, the artificial urinary sphincter is placed through a cut made between the scrotum and anus. A smaller incision is made in the groin for implanting the reservoir. Antibiotics are used to prevent urinary tract infections. The procedure usually takes between 2 and 4 hours.
In women, the device can be implanted either through a cut in the lower abdomen or through the vagina. Postoperative management is similar to that for men.
What happens right after the procedure? After the surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. He or she will have a narrow tube, called a urinary catheter, in the bladder to drain the urine for a few days. An individual usually stays in the hospital for 2 to 4 days after the procedure.
What happens later at home? Oral antibiotics are usually prescribed for 1 to 2 weeks following the surgery. Activity is restricted for 2 to 6 weeks, depending on how the surgery was done. The person is advised to abstain from sexual activity until the device has been activated.
The doctor will activate the device 1 to 2 months after the sphincter is implanted. He or she also teaches the person how to use the device. The person will be taught to empty the bladder "by the clock" to prevent dangerous urinary retention.
If a person with this device ever needs a urinary catheter, the sphincter will be deactivated before it is passed through the urethra. This will help to prevent damage to the urethra and possible cuff erosion.
Most people are able to control their urination with this device. Some people do need a revision or replacement of the device if it doesn't work well or if it breaks.
What are the potential complications after the procedure? There is almost always short-term urinary retention after this procedure. This is due to swelling inside the cuff. Urinary retention lasts for a longer time in some people. This might be due to a blockage in the urinary tract. Small blood blisters associated with the surgery are not uncommon. There is also the chance of infection or cuff erosion occurring. This might result in the need to remove the device.
Author: Stuart Wolf, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
