Inflatable artificial sphincter
Urinary control (continence) is maintained by a muscular sphincter that surrounds the urethra as it leaves the bladder.
|Procedure, part 1|
An artificial urinary sphincter may be used to treat stress incontinence in men that is caused by urethral dysfunction, which can occur 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 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 or reservoir
- 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 for better visualization 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 - 5 minutes .
|Procedure, part 3|
When inflated, the cuff constricts (narrows) the urethra and blocks passage of urine. When deflated, the cuff reduces pressure on the urethra and allows for free passage of urine.
If you receive an artificial urinary sphincter, you will return from surgery with a Foley catheter in place. The artificial sphincter cuff will 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.
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Senior Physician, Massachusetts General Hospital.
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