West Coast Urology  –  Geelong   |   Hamilton    |   Colac   |   Winchelsea

A. PROF RICHARD GRILLS

DR KATHRYN MCLEOD

MR PATRICK PREECE

Urological Surgeons

Artificial Urinary Sphincter for Men

 

To download a PDF document about ‘artificial urinary sphincters’ please click:

Reasons for performing the procedure

  • It is a surgical treatment for male ‘stress’ incontinence (urine leakage) which typically occurs due to injury of the urethral sphincter.
  • The most common causes of male stress incontinence are:
    • Prostatectomy (removal of the prostate due to cancer)
      • Approximately 10% of prostatectomy patients will have incontinence that persists beyond a year
    • Radiotherapy for prostate cancer
    • Other surgical treatments for benign prostate enlargement (BPH)
    • Pelvic trauma
  • Urine leakage from stress incontinence typically occurs during moments of increased abdominal pressure which overpowers the weakened sphincter mechanism. Such triggers include laughing, sneezing, coughing, bending over, lifting, sex and exercise.


What is an artificial urinary sphincter?

  • It is a prosthetic device that replicates the function of the urethral sphincter.
  • The device has three components:
    • A fluid filled cuff that is individually sized and wrapped around the urethra
    • A ‘deflate’ pump inserted under the skin of the scrotum, and
    • A ‘pressure regulating’ balloon that is buried in the lower abdomen

  • In its resting state, the cuff is pressurised with fluid which keeps the urethra closed and prevents urine leakage.
  • When there is a desire to urinate, the pump in the scrotum is pressed which deflates the cuff and opens the urethra.
  • The cuff will then automatically refill with fluid over a few of minutes, closing off the urethra again.


Results

  • The artificial sphincter aims to improve male stress incontinence by at least 80%, with many men made completely ‘dry’.
  • Small incontinence episodes may still occur, particularly during moments of increased activity with a full bladder.


Alternative stress incontinence treatments

Though the artificial urinary sphincter can be a life-changing operation for men bothered by urinary incontinence, your surgeon will discuss any other appropriate alternative strategy. These treatments can include:

  • Lifestyle modifications
  • Pelvic floor physiotherapy
  • Penile clamps
  • Catheters
    • Condom catheter
    • Indwelling catheter
  • Male urethral ‘sling’
    • This is an alternative surgical incontinence solution that is suitable for some men.


TO FIND OUT MORE

  • The procedure takes 1-2 hours and is performed under a general anaesthetic.
  • The artificial urinary sphincter is implanted through two small wounds- one between the legs (behind the scrotum), and another on the lower abdomen. A temporary catheter is inserted during the surgery.
  • Usually only an overnight stay in hospital is required. The catheter is removed prior to discharge the next morning.
  • It is important that the artificial sphincter remains ‘deactivated’ for 6 weeks following surgery to allow the body to completely heal prior to its use. It will be ‘switched on’ by the surgeon at a scheduled follow up appointment.
  • Bleeding- Some bruising between the legs, of the scrotum or lower abdomen is common. It usually settles quickly. Major bleeding is rare.
  • Infection- Minor wound infections can be treated successfully with antibiotics. Severe infections involving the implant are thankfully uncommon (<5%), but may require removal of the artificial sphincter.
  • Urethral injury- An unlikely complication. Nonetheless, if the urethra is injured during the procedure it will be repaired, and insertion of the artificial sphincter postponed a few months.
  • Erosion- If the artificial sphincter erodes through the wall of the urethra it results in device failure and infection, necessitating removal. Never let anyone try to insert a catheter without first talking to your surgeon or another urologist, as this can cause an erosion.
  • Device malfunction- The hydraulic system can wear out over time. The average ‘life expectancy’ of an artificial sphincter is approximately 7-8 years. A faulty artificial sphincter can be replaced through revision surgery.

Other important investigations

  • Two special tests are usually performed in the lead up to surgery to confirm that an artificial urinary sphincter is the most appropriate treatment:
    • Cystoscopy (the urinary tract anatomy is assessed by passing a telescope through the penis up to the bladder)
    • Urodynamic studies (a test that analyses the behaviour of your bladder to evaluate other possible causes of urinary incontinence)


Pre-operative tests:

  • 7-10 days prior to surgery you will have routine blood tests and provide a urine specimen to check for any infection. You will be notified if you require antibiotics in the lead up to surgery.


Before the surgery:

  • DO NOT shave around the penis and scrotum in the weeks leading up to surgery- you will be freshly shaved at the time of surgery to minimise the risk of infection.
  • Please ensure good genital and groin hygiene. It is important you notify your surgeon if you develop any rashes or infections (e.g. jock itch) prior to surgery.


Medications to stop:

  • Notify your surgeon if you take any blood thinners, medications for diabetes or medicationsthat weaken your immune system as these may need to be withheld in the lead up to surgery.


Antibiotics

  • To minimise the risk of infection, antibiotics are used during and after the surgery.
  • Please notify your surgeon if you have any known allergies (e.g. penicillins).
  • One of the antibiotics sometimes used during the surgery is called Gentamicin. It is a very effective antibiotic but has some potential (although fortunately rare) complications:
    • Tinnitus (a ‘ringing in the ear’, which in some cases may be irreversible)
    • Kidney damage (although usually only occurs with prolonged use)
  • It is important you notify your surgeon if you have pre-existing hearing difficulties or kidney troubles.

Wound care

  • All the stitches are dissolvable.
  • Keep the wounds clean and dry for 48 hours after surgery. You can then shower as normal, carefully drying the wound afterwards (pat dry with a towel or use a hair dryer)
    • Avoid baths or long showers which may macerate or ‘soften’ the skin around the wound
  • The waterproof wound dressings will be removed at a review appointment with the nurse in the week following surgery. If the dressings become wet or fall off beforehand, you can leave the wound exposed.
  • The artificial sphincter is de-activated for a period of 6 weeks following the surgery, which means you will still be incontinent during that period. It is important that the wound between the legs is not sitting in a wet pad for long periods. You should use either a penile clamp or change pads more frequently than usual to keep the wound as clean and dry as possible.

 
Recovery

  • Swelling and bruising can last for a week or two. Pain and discomfort may persist for several weeks.
  • Constipation is common following surgery and is often exacerbated by the use of strong pain medication. It is important to avoid straining on the toilet which can increase the risk of bleeding etc following surgery.
  • To prevent/ treat constipation, maintain good fluid intake, high fibre foods and use laxatives as required
  • It will take 6 weeks before complete healing occurs. The sphincter remains de-activated for this period.


Exercise and activity

  • Avoid strenuous activity, physical work, sexual activity and exercise for 4 weeks.


Driving

  • It is safe to resume driving only when you are off all pain medications, are moving around freely and are comfortable sitting in an upright position (this is usually sometime after two weeks).


Medications

  • You will be given when you leave hospital:
    • Tablet antibiotics
    • Pain relief medication
    • Laxatives to prevent/ treat constipation


Follow up appointment

  • You will reviewed in the rooms:
    • One week after surgery
    • Six weeks after surgery, to activate and teach you how to confidently use the artificial sphincter

 
If you did not receive an appointment when leaving hospital, please contact reception at West Coast Urology to make one.

Contact your surgeon if you notice any of the following during the recovery period:

    • Fever
    • Worsening pain, increased swelling, redness or wound discharge
    • The wound opening up
    • Any component (e.g. pump or tubing) becoming directly visible
    • Difficulties urinating.
  • It is critical that no one attempts to pass a catheter without first speaking to your surgeon or seeking advice from another urologist. If you are undergoing other future surgery, notify your surgeon that you have an artificial sphincter so they can plan accordingly (as you will often need a catheter).

  • Minimise direct pressure on the urethral cuff, as this may be uncomfortable, and can cause small incontinence episodes. Cyclists should ideally use a split seat (seat with a middle cut out).

  • Reasonable hand dexterity is important to be able to use the pump in the scrotum.

  • Some caution needs to be taken implanting an artificial urinary sphincter in men with other urological problems such as blockages of the urethra (i.e. ‘strictures’) or previous bladder tumours.

  • The artificial sphincter has a ‘lock out’ button, allowing it to be deactivated if needed (temporarily or permanently). The user will be incontinent again until it is reactivated.