Male artificial sphincters for urinary incontinence
An artificial urinary sphincter is used to treat stress incontinence in men, which is caused by urethral dysfunction (usually after prostate surgery). Additionally, this procedure is performed in both men and women with sphincter dysfunctions related to spinal-cord injury or multiple sclerosis. Before resorting to this treatment, most experts advise using medication and bladder-retraining therapy. Alternatives to this procedure include the pubovaginal sling in women, or the periurethral injection of collagen in both men and women.
An artificial sphincter consists of: a cuff that fits around the bladder neck, a pressure regulating balloon, and a pump that inflates the cuff. To treat urinary incontinence, a cuff is placed around the bladder neck so that when it is inflated the urethra closes tightly. The pressure-regulating balloon is placed under the tissues of the lower abdomen. The balloon is then filled with liquid (occasionally, an iodine-based solution is 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. To use the sphincter, compress (squeeze) the pump so that fluid is diverted from the urethral cuff to the balloon. This action enables the sphincter to relax, which in turn, enables you to urinate. The cuff re-inflates on its own in three to five minutes.
When inflated, the cuff constricts the urethra and blocks the passage of any urine. When deflated, the cuff reduces pressure on the urethra and allows for the free passage of urine.
A foley catheter is also inserted during surgery, which is removed prior to discharge from the hospital. The artificial sphincter cuff is not inflated immediately after surgery, in order to allow the tissues to heal. About six weeks after surgery, you will be taught how to activate the pump that inflates the artificial sphincter.
About the AMS Sphincter 800™ Urinary Control System
- The AMS Sphincter 800 Urinary Control System (also called the Artificial Urinary Sphincter, or AUS) provides patients simple, discreet urinary control.
- The device is implanted entirely within the body. It simulates natural bladder function by mimicking the action of a healthy sphincter muscle.
- The AMS Sphincter 800 restores continence by keeping the urethra (the tube that carries urine from the bladder to the outside of the body) closed until the patient wants to urinate.
- The AMS Sphincter 800 consists of three components: a cuff that applies pressure to the urethra to keep it closed; a balloon that controls the amount of pressure exerted by the cuff; and a control pump that facilitates patient voiding. The three parts are connected by tubing and filled with saline solution or a contrast medium.
- To urinate, the patient squeezes the pump to move fluid from the cuff to the pressure-regulating balloon. Afterward, the fluid automatically returns from the balloon to the cuff, restoring continence again.
- Since 1972, more than 50,000 Urinary Control Systems have been implanted in men throughout the world. The AUS remains the most effective treatment option for male incontinence following prostate surgery.
- Clinical studies show that the AMS Sphincter 800 is effective in the long term (up to 7.2 years), it restores "social continence" in 80 percent of patients (that is, patients use one or fewer absorbent pads during a day), and 90 percent of patients are satisfied with the device. (Haab, et al, Journal of Urology, August 1997)
- More than 1,300 urologists in North America implant the AMS Sphincter 800. The surgery to implant the system usually last 45 to 90 minutes.
- Medicare and most private insurance carriers cover the AMS Sphincter 800. Patients should verify their individual coverage with their insurance carriers.
- The AMS Sphincter 800 Urinary Control System is manufactured by American Medical Systems, Inc., Minneapolis, Minn. AMS sponsors the Incontinence Information Center, an organization that provides information about the causes and treatments of urinary incontinence to physicians, the public and the media.