Urinary incontinence (UI) is a condition that occurs quite frequently in the general population. Although the condition is not life threatening, UI can significantly impact the patient’s quality of life. UI that is classified as stress UI (SUI) results when the sphincter muscles responsible for retaining urine weaken and fail. When this occurs, a device known as an artificial sphincter may be implanted.
The inflatable artificial sphincter is a device that helps keep urine from leaking from the bladder. The device can be implanted in patients whose sphincter muscles no longer work properly.
A procedure to implant the inflatable artificial sphincter is ordered when a patient develops SUI. This condition is present when urine leaks from the bladder during normal activities, such as walking, coughing, lifting objects, or exercising. The procedure may be ordered for men following prostate surgery, to help them reduce incontinence.
For patients that develop SUI, implantation of the inflatable artificial sphincter is usually the last option for treatment. Patients with SUI are typically first treated with medication and bladder-training to address incontinence. If these treatments fail, surgical intervention may be recommended.
In order to prepare for this procedure, your doctor may ask you to fast for six to 12 hours before scheduled surgery. Fasting will include no intake of food or liquids by mouth. Patients who take medications for other health conditions must discuss these issues with their doctor. Your doctor will provide instructions on whether or not to take medications before the procedure. Patients will also be required to complete a urine test to ensure that no infection is present before the procedure.
The placement of the inflatable artificial sphincter is a surgical procedure. Patients undergoing this procedure will be given either general or spinal anesthesia, and therefore will feel no pain during the procedure. Patients under general anesthesia will be unconscious. Spinal anesthesia, on the other hand, numbs the patient’s body from the waist down. The patient is awake during the procedure, but feels no pain.
The stages of the procedure include surgical placement of the device, postoperative recovery, and patient education regarding how to use the device. The surgical placement of the device is best explained by reviewing the parts of the inflatable artificial sphincter and how they are implanted. The inflatable artificial sphincter has three parts:
- the cuff
- the balloon
- the pump
The cuff is placed around the tube that carries urine from the bladder out of the body (urethra). Surgical placement of the cuff requires an incision. The incision will be made in one of three places:
- the scrotum (men)
- the labia (women)
- the lower belly (men and women)
Once the cuff is in place, the balloon is also inserted. The balloon holds the same type of liquid that is in the cuff. The pump is not needed until the patient is able to use the device (approximately six weeks following surgery).
Following the procedure, you can expect to have a Foley catheter in place in the urethra. A Foley catheter is a soft tube, made of either rubber or plastic, which is used for draining urine from the bladder. It can be used while healing from this surgery. Before leaving the hospital, the Foley catheter will be removed. However, you will not be able to use the inflatable artificial sphincter for several weeks. Because the body needs time to heal, the cuff cannot be inflated. During this time, you will remain incontinent.
Approximately six weeks following the procedure, you will be taught how to use the pump. The pump is used to move fluid between the cuff and the balloon. Squeezing the pump moves fluid from the cuff to the balloon so that the cuff is loose and urine can flow through the urethra. The fluid from the balloon moves back to the cuff in 90 seconds. With the cuff reinflated, urine is not able to leak out of the bladder. The pump will be needed each time you need to empty your bladder.
Risks for this procedure are minimal and the procedure is considered to be relatively safe. However, as with all surgical procedures, there are important risks that must be considered. General risks associated with surgery include:
- infection at the site of the incision, or other infections
- development of blood clots in the legs, which can travel to the lungs
- breathing problems
Additionally, there are some risks that are specific to this procedure. These include:
- damage to organs including the urethra, bladder, or vagina
- increased incontinence
- increased difficulty emptying the bladder, requiring a catheter
- failure of the device, requiring removal
The inflatable artificial sphincter can provide you with the ability to effectively control SUI. In patients whose incontinence has become severe, the impact on quality of life can be quite substantial. In these instances, placement of the inflatable artificial sphincter may be crucial for restoring quality of life.
Although the initial success for achieving this goal is high following surgery, changes in the function of the inflatable artificial sphincter may occur over time. The tissue around the cuff may erode, or the cuff may lose its elasticity. When this occurs, incontinence may return. Patients may need to have the device removed or replaced in order to address these problems.