Inflatable artificial sphincter - series?

Answer 1

Normal anatomy

Urinary continence is maintained by a muscular sphincter that surrounds the urethra as it exits the bladder.

Procedure, part 1

An artificial urinary sphincter is used to treat stress incontinence in men that is caused by urethral dysfunction such as after prostate surgery. Additionally this procedure may be performed in men and women with sphincter dysfunction related to spinal cord injury or multiple sclerosis. Most experts advise their patients to try medication and bladder retraining therapy first before resorting to this treatment. Alternatives to this procedure are the pubovaginal sling in women or the periurethral injection of collagen in men and women.

Procedure, part 2

An artificial sphincter consists of three parts:

• a cuff that fits around the bladder neck
• a pressure regulating balloon
• a pump that inflates the cuff.

To treat urinary incontinence, the cuff is placed around the bladder neck so that when it is inflated, the urethra will close tightly. The pressure regulating balloon will be placed under the tissues of the lower abdomen. The balloon is filled with a liquid (occasionally, an iodine-based solution will be used so that it will be visualized when x-ray procedures are performed). The control pump mechanism is placed in the labia for women, and in the scrotum for men. To use the sphincter, the person will compress (squeeze) the pump to divert fluid from the urethral cuff to the balloon. This action will allow the sphincter to relax so that the person can urinate. The cuff will then re-inflate on its own in 3 to 5 minutes .

Procedure, part 3

When inflated, the cuff constricts the urethra and blocks passage of any urine. When deflated, the cuff reduces pressure on the urethra and allows for free passage of urine.

Aftercare

If you had an artificial urinary sphincter placed, you will return from surgery with a foley catheter in place, which will be remove prior to discharge. The artificial sphincter cuff will be not be inflated immediately after surgery to allow the tissues to heal. About 6 weeks after surgery you will be taught how to activate your pump to inflate the artificial sphincter.

Reviewed By

Review Date: 06/17/2010

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia.