Artificial Urinary Sphincter Implantation

An artificial urinary sphincter is an implantable device used to treat severe urinary incontinence, usually a consequence of previous prostate cancer surgery. It is composed of three components, all of which are totally internal: a 2cm inflatable silicone cuff which fits around the urethra and compresses it, a golf ball sized reservoir containing fluid which sits behind the pubic bone and a small pump which sits within the scrotum. The cuff is deflated by squeezing the scrotal pump and this allows voiding.

 Procedure

Surgery is performed under a general anaesthetic. The skin in the surgical field is scrubbed with disinfectant for several minutes. A 5cm cut is made at high on the scrotum - this gives access to the urethra, scrotum and retropubic area which is where the reservoir will sit. The individual components are implanted then connected together. A catheter is not left in place. Afterwards, most patients re able to head home the following day. The device will not be activated until six weeks later - this gives time for resolution of swelling. Once the device is activated (by firmly squeezing the pump) then you should become completely continent.

 Pre-procedure

Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications.

A urine sample needs to be provided to the laboratory 1 week prior to surgery.

 Post-procedure

There will be bruising and swelling of the penis and scrotum and this will takes several weeks to resolve. Until the device is activated you will continue to leak urine and require pads. You will need to take antibiotics for two weeks following surgery.

Activation takes place six weeks following surgery. It takes a little practice to become adept at using the scrotal pump.

 Return to work

Most men can return to work 2 weeks following surgery. Heavy lifting and straining should be avoided for six weeks.

 Follow up

I will see you six weeks following surgery to activate the device.

 Other Risks

Infection of the device is uncommon however quite serious as it means that the whole device may need to be removed. We are very careful to reduce the risk of this occurring. If the device needs to be removed then another device can be implanted after  three months.

Erosion of the cuff into the urethra. Again, an uncommon event but it does require device removal and delayed replacement.

Urethral atrophy. Constant compression of the urethra by the cuff may lead to shrinkage of this segment of the urethra   and consequent reduction of compression pressure leading to urine leakage. The chance of this occurring rises with time, after ten years approximately 50% of men have had this occur. The treatment for this is fitting a smaller cuff or a second cuff.

Failure of the device. This covers all of the potential causes of mechanical failure such as fluid leakage, pump failure etc. It is uncommon.