The artificial urinary sphincter is an implantable device made of solid silicone elastomer (filled with liquid), used in the treatment of severe stress urinary incontinence.
It is designed to restore the natural process of urinary control. The device stimulates urinary function in a normal way by opening and closing the urethra according to the patient's wishes.
Photo: Boston Scientific
What are the indications for the placement of an artificial urinary sphincter?
This device is used in the treatment of severe urinary incontinence in men due, for example, to the consequences of prostate surgery (prostatectomy).
As the device requires some manipulation of the pump and valve to open and close the sphincter, the patient must have the necessary strength and dexterity to perform these maneuvers.
What are the contraindications for the placement of an artificial urinary sphincter?
This device is contraindicated in patients considered to be unsuitable candidates, either because of the risks related to the operation, physical condition (e.g. dexterity) or mental condition (e.g. cognitive function).
This device is also contraindicated in patients suffering from hyperreflexia or bladder instability, or urinary incontinence complicated by lower urinary tract obstruction.
Finally, implantation is contraindicated in patients suffering from allergies to certain products contained in the device (e.g. tetracyclines), suffering from certain systemic conditions (e.g. lupus erythematosus) or having a high level of fibrosis due to a history of surgery or radiotherapy in this region.
How does the device work?
When the patient wants to urinate, he squeezes and releases the pump implanted in the scrotum several times. This causes the fluid in the sleeve to move towards the balloon. The sleeve opens and urine flows into the urethra. The balloon then automatically restores the pressure in the sleeve, as the fluid returns.
Photo : Boston Scientific
What are the details of the surgery?
The surgery is performed at the Centre Métropolitain de Chirurgie, the only private hospital in Quebec. The patient is placed on his or her back, in the gynecological position, and usually under spinal anesthesia.
The surgery lasts on average two hours. Once all the components are in place and everything has been tested, the device will be deactivated and a urinary catheter will be installed.
What are the risks and possible complications?
The following adverse events may be associated with the implantation or use of the device: infection, bleeding or hematuria, edema, erosion under the cuff, dysuria or bladder spasms, pain or discomfort, perforation or extrusion, nerve damage & device breakage.
Is it possible to travel or have x-ray exams with this device?
Yes, you can travel with peace of mind!
You can pass the detectors without any problem, but it is strongly recommended to have proof that you have a sphincter implant; the device identification card fits discreetly into a wallet.
Yes, you can have X-ray exams, without any problem!
This device can be subjected to an MRI exam safely, but under certain conditions. It is therefore important to notify the doctor when requesting that you have an implant, so that everything is well documented and the radiology technician can adjust the necessary parameters.
Furthermore, it is essential that any member of the medical staff you consult is informed of this associated medical condition, especially in the event of an emergency in a state of unconsciousness. With this in mind, the patient should have on him (wallet) a notice to this effect with identification of the implant.
References
- Sandhu J. S. & Al. Incontinence After Prostate Treatment: Aua/Sufu Guideline. 2018
- Gacci M. & Al. European Association of Urology Guidelines On Male Urinary Incontinence. 2022