Urinary incontinence (UI) is a condition that occurs quite frequently in the general population. It's not life-threatening, but UI can significantly impact your quality of life. UI that is classified as “stress UI (SUI)” results when your sphincter muscles, which retain urine, stop working properly. When this occurs, your doctor may implant a device known as an artificial sphincter.
The inflatable artificial sphincter helps keep urine from leaking from the bladder.
The inflatable artificial sphincter is used when a patient develops SUI. You'll know you have SUI if urine is leaking from your 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, or lack of control over their bladder.
Implantation of the inflatable artificial sphincter is usually the last resort for treatment of SUI. Patients are typically first treated with medication and bladder-training to help with incontinence. If these treatments fail, surgical intervention may be the next step.
In order to prepare for implementation of the artificial sphincter, your doctor may ask you to fast for six to 12 hours before your surgery. That means no food or liquids taken by mouth.
If you take medications for other health conditions, talk about them with your doctor. They'll let you know whether or not to take them before the procedure.
You’ll also need to complete a urine test to make sure you don't have an infection before the procedure.
The placement of the inflatable artificial sphincter is a surgical procedure. You'll receive either general or spinal anesthesia so that you won’t feel any pain while in surgery. If you're under general anesthesia, you'll be unconscious. Spinal anesthesia numbs your body from the waist down, so you'll be awake but won't feel any pain.
There are three stages of the procedure:
- surgical placement of the device
- postoperative recovery
- education about how to use the device
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, called the 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, which is roughly 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, but you won't be able to use the inflatable artificial sphincter for several weeks. Your body needs time to heal and can't inflate the cuff. During this time, you'll remain incontinent.
Approximately six weeks following the procedure, you’ll learn 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. You'll need the pump each time you need to empty your bladder.
This procedure is considered relatively safe, and risks are minimal. As with all surgical procedures, there are important risks you must consider. 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
There are also 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 help you control SUI. This can greatly improve the quality of life if you suffer from severe incontinence.
Be aware that 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. You may need to have the device removed or replaced in order to address these problems.