Inflatable artificial sphincter

Alternative names:

artificial rectal sphincter; artificial urinary sphincter

Definition:

This is a surgical procedure to insert an inflatable artificial sphincter to treat either urinary stress incontinence (artificial urinary sphincter will be inserted) or fecal incontinence (artificial rectal sphincter will be inserted) caused by a sphincter dysfunction.

Description:

Since the procedure for placement of the artificial urinary sphincter and the artificial rectal sphincter is similar, they will be discussed together.

An artificial sphincter consists of three parts:

• a cuff that fits around the bladder neck (or anal canal for the artificial rectal sphincter)
• a pressure regulating balloon
• 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. To treat fecal incontinence, the cuff is placed around the anal canal.

The pressure regulating balloon will be placed in the abdominal cavity. The balloon is filled with a liquid (occasionally, an iodine-based solution will be used so that it will be visualized 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 (or anal) cuff to the balloon. This action will allow the sphincter to relax so that the person can urinate (or defecate). The cuff will then re-inflate on its own in 3 to 5 minutes (10 minutes for the artificial rectal sphincter).

The artificial sphincter is placed during surgery using general or spinal anesthesia. People having an artificial rectal sphincter may need to be admitted to the hospital prior to surgery to receive medications that cleanse the bowel. The bowel cleansing may include a series of enemas and laxatives, followed by oral antibiotics.

If you had an artificial urinary sphincter placed, you will return form surgery with a foley catheter in place, which will be remove prior to discharge. 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 urethral 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 are the pubovaginal sling in women or the periurethral injection of collagen in men and women.

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.