Inflatable artificial sphincter

Definition

An inflatable artificial sphincter is a device used to treat problems with the urinary or rectal sphincter. Sphincters are muscles that allow your body to hold in urine and feces.

Alternative Names

Description

Inflatable artificial sphincter surgery is used to treat some types of urinary incontinence and fecal incontinence. The artificial sphincter is inserted into an area of the urinary tract or rectum, depending on the specific problem. The procedure is done under general anesthesia or spinal anesthesia.

An artificial sphincter consists of three parts:

• A cuff that fits around the urethra or anal canal (end of large intestine)
• A pressure regulating balloon
• A pump that inflates the cuff

To treat urinary incontinence, the cuff is placed around the urethra. When it is inflated, the urethra will close tightly.

To treat fecal incontinence, the cuff is placed around the anal canal, which is located between the anus and rectum.

The balloon is placed beneath the abdominal muscles and filled with a liquid.

The pump is placed in the labia for women and in the scrotum for men. Alternatively, the pump may be placed underneath the skin of the abdominal wall or thigh.

Squeezing the pump moves fluid from the cuff to the balloon. This action will allow the sphincter to relax so that you can urinate or have a bowel movement. A cuff around the urethra will reinflate on its own in 90 seconds; the artificial rectal sphincter reinflates in about 5 to 9 minutes.

People having an artificial rectal sphincter may be admitted to the hospital before surgery and receive medications that cleanse the bowel. The bowel cleansing may include a series of enemas and laxatives, followed by antibiotics taken by mouth.

If you had an artificial urinary sphincter placed, you may return from surgery with a Foley catheter in place. This catheter will be removed before you leave the hospital. The artificial sphincter cuff will be 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.

Indications

An artificial urinary sphincter is used to treat stress incontinence in men that is caused by sphincter dysfunction such as 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 first before resorting to this treatment. Alternatives to this procedure for men are the male sling or injection of collagen (urethral bulking agent). In women, the pubovaginal sling and collegen injection are alternatives.

An artificial rectal sphincter is used to treat fecal (bowel) incontinence caused by neurological or muscular dysfunction of the sphincter. Once again, it is advised that all potential candidates try bowel and sphincter retraining before resorting to this procedure.

People who are candidates for an artificial sphincter (either the urinary or rectal type), must have the physical ability to toilet and manipulate the sphincter. Additionally, this procedure should not be performed in people who have a progressive urological disease, urinary tract infection, or non-symptomatic presence of bacteria in the urine. The person must be treated with antibiotics and must be free of any urinary bacteria before the procedure may be performed.

Notify your surgeon if you have an allergy to iodine since the balloon is sometimes filled with an iodine solution.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

Additional risks include:

• Infection
• Urinary tract infection
• Urethral erosion
• Mechanical failure of the device (requires removal)

Expectations after surgery

Studies have found that men who were treated for stress incontinence with the artificial urinary sphincter had an 82% cure rate, while women had a 92% cure rate. With time there may be a gradualwasting  of the tissue under the cuff, which may make the device less effective.

Continence is normally maintained with a replacement artificial sphincter.

In studies of use of an artificial sphincter for treating fecal incontinence, 60% of the patients reported success.

Convalescence

It is very important for you to carry or wear medical identification to notify health care providers that you have a artificial sphincter. The artificial urethral sphincter must be deactivated whenever urinary catheterization is performed, and the artificial rectal sphincter may need to be deactivated during rectal procedures or enemas.

Additionally, because the pump mechanism is placed in the labia in women and inside the scrotum for men, you may need to modify some activities (such as bicycle riding) to accommodate this pump.

You must be very attentive to possible signs of infection (urinary frequency, pain or burning with urination, and fever) and erosion (pain at cuff site, bleeding, leakage of urine or stools).