Artificial sphincter for urinary control

An artificial sphincter is an implanted device that was developed to manually control the flow of urine. This device is an option for men who have urinary incontinence that has not been controlled by more conservative methods. Oftentimes this will involve men who have had a radical prostatectomy (removal of the prostate gland), or have undergone radiation therapy for prostate cancer.

Candidates for an artificial sphincter

Not every incontinence patient is a candidate for an artificial sphincter. In general, patients typically have severe symptoms, have failed medications, biofeedback, and other surgical approaches. Before considering an artificial sphincter, the patient’s bladder must be:

• Large enough to hold urine between times of urination.
• Neurologically intact.
• Not contracting on a regular basis causing high bladder pressures, urinary urgency, or frequent urination.
• Free from infection before implantation.
• 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 an artificial sphincter.

How well does an artificial sphincter work?

Most people treated with an artificial sphincter regain continence (bladder control) or have a significant improvement in their ability to stay dry. With time, there may be a gradual wearing of the tissue under the cuff of the sphincter, which may lead to a decrease in the effectiveness of the device.

Surgery overview

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.
• A pump to control inflation and deflation of the cuff located in the scrotum.

For men, the surgical procedure can be done through a small incision in the scrotum, or between the scrotum and rectum. After entering the pelvis, the urethra is located and separated from the surrounding structures.

A donut-like cuff is placed around the urethra where it comes out of the bladder. This cuff is then attached to a pump mechanism that is placed in the scrotum next to the testicles. The pump has a small reservoir holding 25 cc (about 2½ tablespoons) of saline. This reservoir is placed behind and above the pubic bone, and pushes fluid into the cuff around the urethra. This cuff compresses these structures acting as an artificial sphincter or valve.

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. Many surgeons advise their patients to deactivate the device each night, and reactivate it in the morning for use during the day. This gives the urethra or bladder a “rest” from the pressure of the cuff, and reduces the wear on tissue. The patient is also instructed to empty the bladder on a schedule to prevent dangerous overfilling of the bladder.

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 the device is implanted, patients should watch for signs of:

• Infection
• Urinary frequency
• Pain with urination
• Burning with urination
• Fever
• Urine leakage
• Bleeding

The provider should be notified if these conditions occur.

Risks of artificial sphincter surgery

Complications with artificial sphincter procedure are:

• Failure of the implant to function properly.
• Infection.
• Erosion of the device, through the tissue, in the area of sphincter placement.

If you are experiencing urinary leakage, contact Urology Austin to schedule an appointment with one of our specialists.