Urinary incontinence in men is a common condition that significantly impacts quality of life. It involves involuntary urine leakage, often due to weakened control over the urinary sphincter. This weakening can occur following prostate surgery or radiation therapy to the prostate area.
For those struggling with sphincter control, an artificial sphincter may be a viable solution. This blog post will explore how artificial sphincters function and what users can expect from this treatment. Whether you are considering this option for yourself or gathering information for a loved one, our aim is to provide valuable insights into the benefits and workings of artificial sphincters.
Common Types of Incontinence
Identifying the specific type of incontinence is important for selecting the most effective treatment. Here are the different types:
- Stress Incontinence: Triggered by pressure on the bladder during activities like coughing, sneezing, or exercising.
- Urge Incontinence: Characterised by a sudden, intense urge to urinate, followed by involuntary leakage.
- Overflow Incontinence: Occurs when the bladder cannot completely empty, leading to dribbling.
- Functional Incontinence: Arises when physical disability or external obstacles prevent timely access to a toilet.
For severe cases, surgically implanted devices such as artificial sphincters can provide controlled urinary retention and significantly enhance a patient’s control over bladder function.
The Artificial Sphincter
An artificial sphincter is a surgically implanted device that mimics the function of the body’s natural urinary sphincter. a It consists of three main components:
- Cuff: Encircles the urethra and controls urine flow.
- Pressure-regulating Balloon: Maintains constant pressure and aids in urinary retention.
- Pump: Placed in the scrotum, allowing the user to manually control the cuff.
By squeezing the pump, the cuff opens, allowing urine to pass, and then automatically refills to recreate a tight seal around the urethra, thus preventing leakage. This mechanism provides a high level of control and aims to restore urinary function.
Surgical Procedure for Installing an Artificial Sphincter
The installation of an artificial sphincter is typically performed under general anaesthesia and involves several key steps:
1. Preoperative Assessment
Before surgery, a thorough evaluation is conducted to assess the patient’s medical history, current urinary function, and overall health to ensure they are suitable candidates for the device.
2. Incision and Placement
The surgeon makes an incision in the perineum (the area between the scrotum and anus) or lower abdomen, and the artificial sphincter cuff is then positioned around the urethra. This placement is important for ensuring the cuff exerts enough pressure to prevent urinary leakage, while also avoiding any restriction of blood flow.
3. Connecting the Components
The cuff is connected via tubing to the pressure-regulating balloon, which is typically implanted in the lower abdominal wall. The pump is placed within the scrotum.
4. Testing the Device
Before closing the incisions, the surgeon will test the cuff’s functionality by activating it to close and then open, ensuring it can effectively restrict and permit urine flow as required.
5. Closure and Recovery
Once the device is confirmed to be functioning properly, the incisions are closed, and the patient is moved to recovery.
Post-Surgical Care and Management
Here is what patients need to know about the immediate care following surgery, device activation, regular follow-up visits, and necessary lifestyle changes to manage their new condition effectively.
Immediate Post-Operative Care
Patients typically spend several days in the hospital under close monitoring to manage pain and prevent infection.
Activation of the Device
The artificial sphincter is usually deactivated during surgery to allow the tissues to heal. It is typically activated about 4 to 6 weeks post-surgery, during which patients are taught how to operate the pump.
Follow-up Visits
Regular follow-up appointments are essential to monitor the healing process, adjust the device settings if necessary, and address any concerns.
Lifestyle Adjustments
Patients are advised on lifestyle adjustments that may include dietary modifications to manage fluid intake and avoid bladder irritants. Physical activities that could impact the device’s function are also discussed, with guidelines provided on safe exercises.
Potential Complications and Risks
While the artificial sphincter is a highly effective treatment for severe urinary incontinence, like any surgical intervention, it comes with potential complications and risks.
- Infection: There is a risk of infection at the surgical site or involving the implanted device itself.
- Mechanical Failure: The components of the artificial sphincter, such as the cuff or pump, may malfunction, requiring additional surgery for repair or replacement.
- Urethral Atrophy: Prolonged pressure exerted by the cuff on the urethra can lead to tissue atrophy, which might compromise the effectiveness of the device or necessitate further intervention.
- Erosion: The device can erode the urethral tissue or the skin of the scrotum where the pump is placed, potentially leading to exposure of the device and requiring surgical correction.
- Urinary Retention: Some patients may experience difficulty urinating, necessitating temporary or permanent adjustment or device removal.
Conclusion
The artificial sphincter is a significant advancement in the management of severe urinary incontinence in men, particularly those whose condition stems from prostate surgery or sphincter damage.
By simulating the natural function of the urinary sphincter, this device offers a viable solution for restoring urinary control and enhancing quality of life.
While the procedure involves complex surgical intervention and carries potential risks, the benefits often outweigh these risks for patients who have yet to respond to other treatments. With proper management and regular follow-up care, it can significantly improve the lives of those suffering from severe incontinence.
