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Inflatable artificial sphincter
Alternative namesArtificial sphincter - rectal or urinary
DefinitionThis is a surgical procedure to insert an inflatable artificial sphincter to treat either urinary sphincteric incontinence (artificial urinary sphincter will be inserted) or fecal incontinence (artificial rectal sphincter will be inserted) caused by a sphincter dysfunction or injury. The urinary and rectal sphincters are the muscles that allow you to hold your urine and feces respectively.
Since the procedure for placement of the artificial urinary sphincter and the artificial anal sphincter is similar, they will be discussed together.
To treat urinary incontinence , the cuff is placed around the urethra so that when it is inflated, the urethra will close tightly. To treat fecal incontinence , the cuff is placed around the anal canal.
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).
IndicationsAn 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.
RisksRisks for any anesthesia are:
Possible complications of this surgery include wound infection, urinary tract infection , urethral erosion , or mechanical failure of the device requiring its removal.
Expectations after surgeryMen who were treated for stress incontinence with the artificial urinary sphincter had a 82% cure rate, while women had a 92% cure rate. With time there may be a gradual atrophy ( wasting ) of the tissue under the cuff, which may lead to a decrease in the effectiveness of the device.
In early studies of use of the artificial rectal sphincter for treating fecal incontinence , 60% of the people reported successful treatment of their fecal incontinence.
ConvalescenceIt is very important for you to carry a medical identification card and/or Medic-Alert bracelet to notify all 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 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).
Update Date: 5/2/2002David R. Knowles M.D., Department of Urology, New York-Presbyterian Hospital Columbia Campus, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT