Inflatable artificial sphincter

Alternative names
Artificial sphincter - rectal or urinary

Definition

This 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 your body to hold urine and feces, respectively.

Description

An artificial sphincter consists of three parts:

     
  • A cuff that fits around the bladder neck (or anal canal for the artificial rectal sphincter)  
  • A pressure regulating balloon  
  • A pump that inflates the cuff

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.

The pressure-regulating balloon will be placed beneath the abdominal muscles. The balloon is filled with a liquid (occasionally, an iodine-based solution will be used so that it will be visualized when X-ray procedures are performed).

The control pump mechanism is placed in the labia for women and in the scrotum for men. Alternatively, the pump may be placed underneath the skin of the abdominal wall or thigh.

To use the sphincter, the person will squeeze the pump to divert urine (or feces) from the cuff to the balloon. This action will allow the sphincter to relax so that the person can urinate (or defecate). The cuff will then reinflate on its own in 3 to 5 minutes; the artificial rectal sphincter reinflates in 10 minutes.

The procedure for placement of an artificial urinary sphincter and an artificial anal sphincter is similar and is performed during surgery using general or spinal anesthesia. People having an artificial rectal sphincter may be admitted to the hospital prior to surgery to receive medications that cleanse the bowel. The bowel cleansing may include a series of enemas and laxatives, followed by oral antibiotics.

If you had an artificial urinary sphincter placed, you will return form surgery with a Foley catheter in place, which will be removed prior to discharge. The artificial sphincter cuff will be not be inflated immediately after surgery to allow the tissues to heal. About 6 weeks after surgery you will be taught how to activate your pump to inflate the artificial sphincter.

Indications

An 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.

RISKS
Risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

Risks for any surgery are:

     
  • bleeding  
  • infection

Additional risks include:
Possible complications of this surgery include wound infection, urinary tract infection, urethral erosion, or mechanical failure of the device requiring its removal.

Expectations after surgery

Studies have found that men who were treated for stress incontinence with the artificial urinary sphincter had an 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 studies of use of an artificial sphincter for treating fecal incontinence, 60% of the patients reported success.

Convalescence

It is very important for you to carry or wear medical identification to notify 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 inside 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).

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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