An artificial urinary sphincter is a device that is designed to compress the urethra in order to treat stress incontinence (involuntary urinary leakage), eg post-prostatectomy incontinence. It is a highly effective device (up to 90% of patients can achieve dryness), but over time there may be need for further surgery to adjust or replace the device.
The artificial sphincter is made up of three parts (see image) – a circular cuff that is placed around the water pipe (urethra). This cuff acts like a valve, controlling the flow of urine from the bladder. The cuff is connected to a small pump that sits in the scrotum (above the testicle) and is also connected to small fluid-filled balloon that sits in the abdominal wall.
The artificial sphincter will control the release of urine from the bladder by staying closed until activated. Squeezing the pump a few times will take pressure off the urethra and allow bladder emptying; the cuff then automatically re-fills over 90 seconds or so.
The operation to insert the device involves a small cut in the perineum (the area between the anus and scrotum) for the cuff to be placed around the water pipe. A separate cut will be made in the groin to insert the pump in the scrotum and the balloon in the abdominal wall.
The operation usually takes around an hour or so, and is usually done under a general anaesthetic (you will be asleep), and usually involves a one-night stay in hospital. The catheter (bladder tube) is removed the following morning, and the artificial sphincter left deactivated (switched off) for 6 weeks after the operation, to allow everything to heal.
After the 6 weeks, you will be seen in the clinic and the device activated (switched on). It is usually apparent straight away whether the surgery has been effective, and if all well then you will be reviewed in the outpatient clinic every 6-12 months.