Sphincters are muscles that allow your body to hold in urine. An inflatable artificial (human-made) sphincter is a medical device that keeps urine from leaking when your sphincter no longer works well. When you need to urinate, the cuff of the artificial sphincter can be relaxed so urine can flow out.

See also:

• Anterior vaginal wall repair
• Urinary incontinence - collagen implants
• Urinary incontinence - retropubic suspension
• Urinary incontinence - tension-free vaginal tape

You will have either general anesthesia or spinal anesthesia before the procedure. With general anesthesia, you will be unconscious and will not feel pain. With spinal anesthesia, you will be awake but numb from the waist down, and you will not feel pain.

An artificial sphincter has 3 parts:

• The cuff fits around your urethra (the tube that carries urine from your bladder to the outside). When it is inflated (full), the cuff closes off your urethra to stop urine flow or leakage.
• The balloon is placed under your belly muscles. It holds the same liquid as the cuff.
• The pump is placed in the scrotum (for men) or underneath the skin in the lower belly or leg (for women). The pump inflates the cuff.

An incision (cut) will be made in 1 of these areas so that the cuff can be put in place:

• Scrotum (men)
• Labia (women)
• Lower belly (men and women)

Once the artificial sphincter is in place, you will use the pump to deflate (empty) and inflate (fill up) the cuff. Squeezing the pump moves fluid from the cuff to the balloon. When the cuff is empty, your urethra opens so that you can urinate. The cuff will re-inflate on its own in 90 seconds.

Artificial sphincter surgery is done to treat stress incontinence, a leakage of urine when you are physically active (walking, coughing, sneezing, laughing, lifting, or exercising). Men who have problems with urine leakage after prostate surgery have this procedure. Women usually first try other procedures to treat urine leakage before having an artificial sphincter placed.

Most of the time, your doctor will try drugs and bladder retraining before talking about surgery with you.

This procedure is generally safe. Ask your doctor about these possible complications.

Risks for any surgery are:

• Incision infection or the incision opens up
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Other Infection

Risks for this surgery

• Damage to the urethra, bladder, or vagina
• It may be harder to empty your bladder, or you may not be able to empty your bladder and may need a catheter.
• Urine leakage may get worse.
• The device stops working. This requires removing it.

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

Your doctor will test your urine make sure you do not have a urinary infection before starting your surgery.

You may return from surgery with a Foley catheter (tube) in place. This catheter will drain urine from your bladder for a little while. It will be removed before you leave the hospital.

You will not be using the artificial sphincter for a while after surgery. This means you will still be incontinent. Your body tissues need this time to heal.

About 6 weeks after surgery, you will be taught how to use your pump to inflate your artificial sphincter.

You will need to carry a wallet card or wear medical identification that tells health care providers you have an artificial sphincter. The artificial sphincter must be turned off if you need to have a urinary catheter placed.

Women may need to change how they do some activities (such as bicycle riding), since the pump is placed in the labia.

Urinary leakage decreases for many people who have this procedure. But you may still have some leakage. Over time, some or all of the leakage may come back.

There may be a slow erosion (wearing away) of the urethral tissue under the cuff, and this tissue may become spongy. This may make the device less effective.

A new artificial sphincter can help control leakage.

Staskin DR, Comiter CV. Surgical treatment of male sphincteric urinary incontinence: the male perineal sling and artificial urinary sphincter. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 74.