How does an Artificial Sphincter help with urinary incontinence?

Artificial SphincterEven though urinary incontinence is not a serious condition, it can certainly affect a person’s quality of life. Adults with urinary incontinence have to live with the discomfort and occasional embarrassment of wearing diapers, wetting undergarments, or coping with diaper rash. These problems can have unpleasant physical, psychological or social consequences.

There are several possible solutions to this problem. Meditation, exercise and medication can often bring about a satisfactory improvement. However, for urinary leaks that cannot be corrected by these efforts, there is still hope in the form of a surgical procedure involving the implantation of artificial urinary sphincters. A patient is a good candidate for urinary sphincter implantation if he has severe incontinence, is unresponsive to medication, has a bladder that is neurologically intact and without infection, and can empty his bladder completely.

Measure of Success

Most patients who have an artificial sphincter have either regained complete continence or have had their condition dramatically improved. A study found that in over 90% of the study group, the artificial sphincters were working properly even five years after the surgery. However, after several more years it was found that the tissue under the cuff of the sphincter tended to fray in a way that reduced the efficiency of the device.

About the Surgery

An artificial sphincter is made of plastic and has the following components:

  • A cuff which can be inflated and fits around the urethra where it joins the bladder
  • A reservoir placed above the pubic bone that holds the water when the cuff is deflated
  • A pump in the scrotum which controls the inflation and deflation of the cuff

During this surgery for men, a 2 or 3 inch cut is made between the scrotum and the rectum. The urethra is then separated from the surrounding organs and a cuff is placed around it at the point where the urethra comes out of the bladder. This cuff is attached to a pump placed to next to the testicles. The pump is attached to a reservoir which has about 25 cc of salt water. When the patient feels the need to urinate he must squeeze the pump 2 or 3 times so and that the urethra is decompressed and he is able to urinate before the cuff refills. This gives him control in preventing leaks until the next time he feels the need to urinate. The surgery normally takes one hour followed by a 24 hour stay in the hospital.

After the Surgery

Most patients are required to stay at least one night in the hospital following surgery. The device is deactivated for about eight weeks to allow the wounds to heal. The doctor will prescribe oral antibiotics to be taken for one or two weeks. The patient is advised to get plenty of rest and to abstain from sexual activity until the device is activated. The doctor and the patient must watch carefully for signs of infection such as frequent urination, pain, burning sensation, fever, bleeding or urine leakage. Some of the common risks associated with the artificial sphincter operation are its failure to work properly, infection and the device eroding through the surrounding tissue.

Important Points to Consider

An artificial urinary sphincter is a last resort when nothing else has worked. It must be implanted by a highly experienced and skilled surgeon to work properly. The patient must also make lifestyle changes, such as losing weight, in order to increase the chances of becoming completely continent after the surgery.