Parts of an Artificial Urinary Sphincter and Its Surgical Procedure

What Is a Urinary Sphincter?

As the name suggests, the urinary sphincter is a part of the urinary system. Urinary sphincters are muscular structures present between the bladder and the urethra. They control the flow of urine from the urinary bladder to the urethra. The urinary bladder is a bag-like structure that holds the urine temporarily. It is attached to the ureters at one end and the urethra at the other. Normally, the urine flows from the kidneys to the bladder through the tube-like structures known as ureters. When the urine reaches the bladder, the person feels that he needs to urinate and empty the bladder. Here comes the role of the urinary sphincter. When the person urinates, the urinary sphincters relax, and the urine flows from the bladder to the urethra and, finally, out of the body; as soon as the person stops urinating, the urethra sphincters contract and close the urethra.

What Is an Artificial Urinary Sphincter?

An artificial urinary sphincter is a man-made device that helps prevent urine leakage. When the sphincter muscles fail to function properly, the urine leaks out before the person reaches the bathroom. In such a situation, an artificial urinary sphincter can be used to control urine flow. An artificial urinary sphincter consists of three parts described in the table below:

Why Is an Artificial Urinary Sphincter Surgery Done?

Artificial urinary sphincter surgery aims to deal with the problem of stress urinary incontinence. When the urine leaks out while sneezing, coughing, laughing, and doing physical activities, the condition is known as stress urinary incontinence. Artificial urinary sphincter surgery is especially recommended for men who suffer from urinary incontinence. Leakage of urine is a common problem after prostate surgery. There are various other methods of treating urinary incontinence, but sphincter surgery is done when all these methods fail. Women suffer from this condition commonly, but doctors recommend medications and bladder training before opting for sphincter surgery.

How Does the Patient Prepare for the Procedure?

The following things are to be kept in mind before the surgery:

1. The doctor explains the procedure, the benefits, and the side effects. If the patient is willing to undergo the same, he must sign a consent form. The form states that the patient is ready for the procedure and is not under any pressure.

2. The patient should also inform the doctor about the medications he is taking or any allergies or disorders he is suffering from. For example, the doctor might ask to stop taking drugs like Aspirin and Ibuprofen before the surgery, as they can cause excessive bleeding.

3. The patient should not eat anything six to twelve hours before the surgery and only take his prescribed medication in the morning before coming for the procedure.

4. Before the commencement of surgery, general anesthesia will be administered to the patient so that he falls asleep and the surgery is carried out smoothly without any pain or inconvenience.

5. Before the surgery, the doctor asks the patient to undergo a urine test. The urine test helps to check whether the urine is sterile or infected.

What Happens During the Procedure?

After the patient has undergone the urine test and the test reports declare that the urine is sterile and not suffering from a urinary tract infection, the patient is ready for the procedure. The steps of the procedure are listed below:

• First, the patient needs to remove the ornaments and clothing that might interfere with the test.

• An intravenous line is attached to the arm of the patient to administer the general anesthesia.

• After the anesthesia has been administered, the patient goes to sleep and is unaware of his surroundings.

• An incise drape is placed over the abdominal wall to cover the exposed area and prevent the entry of microorganisms.

• The surgeon makes two small incisions, one in the area between the anus and the scrotum area and the labia (in women). Sometimes, the incision might be made in the lower belly, but that is hardly required.

• The area is drained with an antibiotic solution of Gentamicin, Neomycin, and Polymyxin before placing an artificial urinary sphincter.

• Finally, the artificial sphincter is placed in the scrotum or the skin beneath the lower belly.

• When the patient wants to urinate, he needs to squeeze the pump, and the liquid flows from the cuff to the balloon. The patient can urinate, and the cuff gets re-inflated automatically after 90 seconds.

• Finally, the incisions are closed with the help of sutures, and the procedure is complete.

What Happens After the Procedure?

After the procedure is complete, the patient is taken to the recovery room and allowed to remain there until the anesthesia wears off. The blood pressure, pulse, and respiratory rate of the patient are continuously monitored until they become normal. The following devices remain attached to the patient after the surgery:

1. Foley Catheter - The Foley catheter is a tube-like structure inserted into the urinary bladder through the urethra. The catheter will remain in place for a few days to facilitate urine drainage. It will be removed only before the patient leaves the hospital.

2. Intravenous Line - An intravenous line remains attached to the patient for a few days to administer fluids and antibiotics. The patient will not be able to have a normal diet for a few days after the surgery.

3. Inflatable Boots - Inflatable boots are placed on the legs to allow blood circulation through the legs and prevent the formation of blood clots.

How Should the Patient Take Care of Himself at Home?

The devices attached to the patient are removed before the patient leaves the hospital. The urine might leak for a few days after the surgery, but that is normal and subsides after six to eight weeks when the artificial urinary sphincter has been activated. The patient will be called for follow-ups two weeks after the surgery. The following things are to be kept in mind after the surgery:

• Medications - The doctor will prescribe a painkiller, an antibiotic, and a laxative. Painkillers will help to reduce pain after the surgery. Antibiotics will work against microorganisms to prevent bacterial accumulation. A laxative is usually recommended to allow bowel movement and prevent constipation.

• Daily Activities - The person can resume his daily activities after the surgery. However, he needs to wait for six to eight weeks to do strenuous exercise, ride a bike, and lift heavy objects. The patient can take a shower two to three days after the surgery. Make sure to remove the bandages before a shower.

• Scrotal Support - Scrotal support is a device provided by the hospital, and the patient is supposed to wear it for the first week after the surgery. It is designed to support and lift the scrotal sac so that the patient does not feel any pain and inflammation.

What Are the Risks of an Artificial Urinary Sphincter Surgery?

An artificial urinary sphincter is a safe procedure and does not cause any side effects. However, some patients present with the following side effects:

1. Pain.

2. Bleeding from the operated site.

3. Urethral injury.

4. Continuous urine leakage.

5. Irritation due to artificial sphincter devices.

6. Infection.

7. Urinary frequency or difficulty in holding the urine.

8. The device wears off after eight to ten years and needs to be replaced.

When Must the Patient Consult the Doctor?

The patient will be recalled two weeks after the surgery for follow-ups. However, the patient can approach the doctor under the following circumstances:

• High-grade fever.

• Bleeding.

• Swelling.

• Pain even after taking medications.

• Bladder spasms.

• Difficulty in passing urine even with the help of a catheter.

What Are Some of the Other Procedures Used to Treat Urine Leakage?

There are various surgical options available to treat urinary incontinence other than artificial urinary sphincters. Some of them are listed below:

• Sling Surgery - The doctor creates a sling or mesh from the body tissues under the urethra and the bladder neck. The sling closes the urethra during coughing, sneezing, and laughing to prevent urine leakage. Sling surgery is usually performed in males suffering from stress incontinence.

• Bulking Agents - A special type of material (bulking agent) is injected around the urethra to keep it closed and prevent urine leakage. It is helpful in the case of stress incontinence.

Conclusion:

Urinary incontinence is a common problem among men and women and requires treatment at the earliest. An artificial urinary sphincter is one of the surgical options used to treat urinary incontinence. Artificial urinary sphincter surgery aims to replace these sphincters to reestablish normal urine flow. It is a device put into the scrotum, and the patient can squeeze the pump to regulate the flow of liquid from the cuff. The procedure is minimally invasive, and the patient does not have to stay for a long period in the hospital. However, consult the doctor to know more about the procedure and the other treatment options available for urinary incontinence.