Some individuals experience difficulty controlling their urinary sphincter, leading to urinary leakage. This issue may arise after prostate removal surgery or radiation therapy. A possible solution to this problem is the artificial urinary sphincter implantation, a device implanted to treat severe urinary incontinence. Join us as we explore everything you need to know about the procedure for installing an artificial urinary sphincter.
What is a urinary sphincter?
The urinary sphincter is a crucial muscle that functions as a valve, helping the body regulate the flow of urine. When the sphincter is contracted (closed), it prevents urine from leaking by blocking the opening of the bladder. It remains closed until you voluntarily relax it (open), allowing urine to exit the bladder and pass through the urethra.
- The internal sphincter of the urethra is positioned at the end of the urethra where it connects to the bladder. When relaxed, it permits urine to move from the bladder into the urethra. This sphincter primarily consists of the narrow outlet at the base of the bladder (bladder neck) and the prostate
- The external sphincter of the urethra is located within the pelvic floor muscles. When relaxed, it allows urine to flow through the urethra and out of the body
If these muscles lack strength, they can allow urine to leak prematurely, especially during physical activities such as coughing, sneezing, or jumping—a condition known as stress incontinence. In such cases, artificial urinary sphincter implantation steps in to replicate the function of these muscles, enhancing control over urination.
Artificial Urinary Sphincter (AUS)
The artificial urinary sphincter, also known as the artificial urethral sphincter, is a medical device designed to function like a natural urinary sphincter. This inflatable device is used to treat urinary incontinence, a condition characterized by uncontrolled urinary leakage. A surgeon, typically a urologist, implants the device around the urethra. The artificial urinary sphincter contains fluid that keeps it inflated, preventing urine from exiting the body. When the user wants to urinate, they can press a pump, which deflates the artificial sphincter, allowing urine to flow. The device then automatically reinflates after approximately three minutes.
Components of the Artificial Urinary Sphincter
- Urethral Cuff: This cuff surrounds the urethra and regulates urine flow. When closed (filled with fluid), it prevents urine from passing. When open (empty of fluid), it allows urine to flow.
- Pump: The pump is inserted into the skin pouch behind the penis (scrotum) or in the space between the rectum and the genital area (perineum) in men. In women, it is usually placed in the outer labia or folds (labia majora). The pump controls the flow of fluid within the artificial urinary sphincter.
- Balloon: This balloon is positioned beneath the abdominal muscles and contains the same fluid as the cuff. When the urethral cuff is open or deflated, the fluid moves into the balloon.
The artificial urinary sphincter is an effective solution for individuals struggling with urinary control, significantly improving their quality of life.
When Is Artificial Urinary Sphincter Implantation Recommended?
The artificial urinary sphincter implantation is a key treatment option for urinary incontinence, particularly in men who do not respond to other treatments such as medications or bladder training. This type of incontinence often occurs after prostate cancer surgery or benign prostatic hyperplasia (BPH) surgery, leading to urinary leakage during daily activities like laughing, sneezing, coughing, walking, or exercising.
While this procedure is rarely used to treat urinary incontinence in women, they typically explore other treatment options before considering artificial urinary sphincter implantation.
Doctors generally recommend medication and bladder training as initial steps before proceeding with Artificial Urinary Sphincter Implantation surgery.
Artificial Urinary Sphincter Implantation
Pre-Artificial Urinary Rphincter Implantation Preparations
Patients should always inform their doctor about any medications they are taking, including over-the-counter drugs, herbal supplements, and dietary supplements. In the days leading up to the surgery, the doctor may advise the patient to stop taking aspirin or any other medications that could affect blood clotting.
On the day of surgery, patients are typically required to follow several preparation steps, including:
- Avoiding food and drinks for 6 to 12 hours before the procedure
- Taking prescribed medications with a small sip of water, as directed by the doctor
- Arriving at the hospital on time according to the scheduled appointment
- Undergoing a urine test to ensure there is no infection before the surgery begins
During Artificial Urinary Sphincter Implantation
The patient will receive general anesthesia (a medication that induces sleep) before the artificial urinary sphincter implantation begins. Once the patient is in a deep sleep, the surgeon will make two small incisions (surgical cuts) in specific areas—one in the region between the scrotum and the anus, and the other near the lower abdomen.
After completing these incisions, the surgeon will carefully implant the artificial urinary sphincter to ensure the best possible outcome. This step is crucial for improving the patient’s urinary control.
At the end of the procedure, the surgeon will close the incisions using special sutures (stitches). The patient needs to know that these sutures will dissolve naturally over time, eliminating the need for removal later. The patient will receive detailed post-surgery care instructions to ensure a smooth and effective recovery.
Post-Surgery Care for Artificial Urinary Sphincter Implantation
After the procedure, the patient will be transferred to the post-anesthesia care unit, where the anesthesia team will closely monitor them as they recover from the anesthesia. The team will monitor the patient’s temperature, pulse, blood pressure, and oxygen levels to ensure stability. Typically, patients stay in the hospital for one to two nights following surgery.
The patient will have a urinary catheter to help drain urine from the bladder, ensuring comfort during recovery. The nursing team will provide fluids, antibiotics, pain relievers, and other necessary medications via an intravenous (IV) line to support a swift and effective recovery. These medical devices are typically removed before discharge; however, if the patient is sent home with any devices, the doctor will provide detailed instructions on how to manage them.
Patients can resume most of their daily activities the day after surgery, but strenuous activities should be avoided for six weeks. The doctor will advise when sexual activity can safely resume.
Urinary leakage from the artificial urinary sphincter is common after surgery but typically resolves once the doctor activates the sphincter, usually six to eight weeks after the procedure.
Patients can shower 48 hours after surgery. If dressings are present, they should be removed during the shower, and no additional dressings are needed afterward.
Potential Complications of Artificial Urinary Sphincter Implantation Surgery
Although artificial urinary sphincter implantation is generally safe, some potential complications may include:
- Device malfunction or damage, requiring surgical replacement
- Worsening of urinary incontinence
- Difficulty urinating, requiring effort to empty the bladder
- Injury to the urethra, bladder, or nearby organs during surgery
- Problems operating or controlling the device’s pump
- Gradual tissue erosion caused by long-term friction with the device
Follow-up Care After Artificial Urinary Sphincter Implantation Surgery
It is recommended to schedule a follow-up appointment with the doctor two weeks after surgery. However, patients should seek urgent medical attention if they experience any of the following symptoms:
- Fever of 38.3°C (100.9°F) or higher
- Increased bleeding or swelling
- Severe pain that does not improve despite pain medication
- Sharp, painful bladder spasms
- Difficulty urinating
Do not hesitate to seek medical help if any of these symptoms arise, as timely intervention ensures your safety and speeds up recovery.
Alternative Treatment Options for Urinary Incontinence
Several effective alternatives are available for treating urinary incontinence, and the most suitable option is selected based on the severity of the condition and the patient’s overall health status. These alternatives include:
- Conservative Measures: Using urinary incontinence pads, protective underwear, or external devices similar to a condom to collect leaked urine.
- Pelvic Floor Muscle Exercises: These may help improve severe incontinence cases for some patients, but they are often insufficient to achieve complete urinary control on their own.
- Urethral Sling Surgery: A surgical alternative suitable for men with mild to moderate stress incontinence, offering effective symptom relief.
- Urinary Diversion: A surgical procedure that redirects urine flow into a segment of the intestines, allowing it to drain into an external pouch via an opening in the abdominal wall. This is a rare option, used in complex cases where other treatments are unsuitable.
- Permanent Catheterization: A viable option for men who prefer to avoid surgery or whose medical conditions prevent them from undergoing surgical procedures.
These treatment options are carefully evaluated based on the patient’s clinical condition, ensuring the most optimal approach for achieving functional improvement and enhancing quality of life.
Artificial Urinary Sphincter: A Reliable Solution
The artificial urinary sphincter remains an effective and promising option for individuals suffering from severe incontinence after other treatments have failed. Thanks to advancements in medicine and surgery, patients can regain urinary control and significantly improve their quality of life. Ultimately, the decision should be a joint discussion between the patient and the doctor, based on a thorough evaluation of each case.
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