Inflatable artificial sphincter

  • Definition
  • Alternative Names
    • Artificial sphincter (AUS) - urinary

  • Description
    • This procedure may be done while you are under:

      • General anesthesia: You will be asleep and unable to feel pain.
      • Spinal anesthesia: You will be awake, but you will be numb from the waist down and you will not feel pain. You will be given medicines to help you relax.

      An artificial sphincter has 3 parts:

      • A cuff, which fits around your urethra. The urethra is the tube that carries urine from your bladder to the outside of your body. When the cuff is inflated (full), the cuff closes off your urethra to stop urine flow or leakage.
      • A balloon, which is placed under your belly muscles. It holds the same liquid as the cuff.
      • A pump, which relaxes the cuff by moving fluid from the cuff to the balloon.

      A surgical cut will be made in one of these areas so that the cuff can be put in place:

      • Scrotum (men)
      • Labia (women)
      • Lower belly (men and women)

      The pump can be placed in a man's scrotum. It can also be placed underneath the skin in a woman's lower belly or leg.

      Once the artificial sphincter is in place, you will use the pump to empty (deflate) the cuff. Squeezing the pump moves fluid from the cuff to the balloon. When the cuff is empty, your urethra opens so that you can urinate. The cuff will re-inflate on its own in 90 seconds.

  • Why the Procedure Is Performed
    • Man-made sphincter surgery is done to treat stress incontinence. Stress incontinence is a leakage of urine. This occurs with activities such as walking, lifting, exercising, or even coughing or sneezing.

      The procedure is recommended for men who have urine leakage. Leakage can occur after prostate surgery. The man-made sphincter is advised when other medical or surgical treatments do not work.

      Women who have urine leakage most often try other treatment options before having an artificial sphincter placed.

      Most of the time, your health care provider will recommend drugs and bladder retraining before surgery.

  • Risks
    • This procedure is most often safe. Ask your provider about the possible complications.

      Risks related to anesthesia and surgery in general are:

      • Reactions to medicines
      • Breathing problems
      • Bleeding, blood clots
      • Infection

      Risks for this surgery may include:

      • Damage to the urethra, bladder, or vagina
      • Difficulty emptying your bladder, which may require a catheter
      • Urine leakage that may get worse
      • Failure or wearing away of the device that requires surgery to remove it
  • Before the Procedure
    • Always tell your provider what medicines you are taking. Also let the provider know about the over-the-counter medicines, herbs and supplements that you bought without a prescription.

      During the days before the surgery:

      • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
      • Ask your provider which drugs you should still take on the day of your surgery.

      On the day of your surgery:

      • You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
      • Take the drugs your provider told you to take with a small sip of water.
      • Your provider will tell you when to arrive at the hospital.

      Your provider will test your urine. This will make sure you do not have a urinary infection before starting your surgery.

  • After the Procedure
    • You may return from surgery with a catheter in place. This catheter will drain urine from your bladder for a little while. It will be removed before you leave the hospital.

      You will not use the artificial sphincter for a while after surgery. This means you will still have urine leakage. Your body tissues need this time to heal.

      About 6 weeks after surgery, you will be taught how to use your pump to inflate your artificial sphincter.

      You will need to carry a wallet card or wear medical identification. This tells providers you have a man-made sphincter. The sphincter must be turned off if you need to have a urinary catheter placed.

      Women may need to change how they do some activities (such as bicycle riding), since the pump is placed in the labia.

  • Outlook (Prognosis)
    • Urinary leakage decreases for many people who have this procedure. However, there may still be some leakage. Over time, some or all of the leakage may come back.

      There may be a slow wearing away of the urethra tissue under the cuff. This tissue may become spongy. This may make the device less effective. If your incontinence comes back, changes may be made to the device to correct it.

  • References
    • Adams MC, Joseph DB, Thomas JC. Urinary tract reconstruction in children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 145.

      Chapple CR. Retropubic suspension surgery for incontinence in women. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 82.

      Wessells H, Peterson A. Surgical procedures for sphincteric incontinence in the male: artificial genitourinary sphincter and perineal sling. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 91.