Artificial urinary sphincter surgery for the relief of urinary incontinence

Urinary incontinence refers to the involuntary passage of urine, a common problem that affects up to 3 million people in the UK. If you suffer from severe urinary incontinence, however, the implantation of an artificial urinary sphincter can help to resolve symptoms and improve quality of life.

Here, Mr Rowland Rees, renowned consultant urologist and male genito-urethral surgeon, provides an expert insight into artificial urinary sphincter surgery.

What is an artificial urinary sphincter?

An artificial urinary sphincter is a very well-established medical device used to treat stress urinary incontinence.

In men, the commonest indication for an artificial urinary sphincter is incontinence after prostate surgery. Between 5-10 per cent of men who undergo prostate cancer surgery with a robotic prostatectomy will go on to develop some leakage. If the leakage doesn’t resolve itself, then an artificial urinary sphincter is a highly successful device that can solve the issue and consequently improve quality of life.

What does artificial urinary sphincter surgery involve?

Artificial urinary sphincter surgery involves a short procedure that takes around 1 hour.

During the procedure, a small plastic cuff or ring is placed around the urethra (the water pipe) via the perineum. Once the cuff has been fitted, a small pump is placed in the scrotum and a small reservoir is placed in the tummy. These components, which make up the artificial urinary sphincter, are all interconnected.

Once the components have been inserted, the fluid in the system then fills the cuff around the urethra to compress it, closing it enough to prevent leakage. When the bladder is full, squeezing the pump that is placed in the scrotum causes the cuff to empty and release its pressure, allowing the patient to pass urine. The cuff refills automatically after a minute, closing off the urethra once again.

After this, the skin is closed and a catheter may be placed in the bladder overnight. Things are checked two weeks after surgery to make sure that everything is healing nicely. After six weeks, the artificial urinary sphincter is activated.

Are there any risks or side effects associated with the procedure?

As with all operations and anaesthetics, there are some risks involved. The more general risks are bleeding or infection in the wound, but fortunately this is quite rare for this type of surgery.

There can be some residual leakage, where although urinary continence may be fully restored (no pads or any other devices are needed), it’s more common to require one small pad a day due to a small amount of residual leakage - particularly with straining, coughing, or sneezing.

Very rarely, fortunately, the placement of the cuff around the urethra can lead to cuff erosion, which is the erosion of the urethra. This is an unusual complication that occurs if the cuff around the urethra is placed too tightly or if the blood supply to the area is not good enough, and that requires the removal of the artificial urinary sphincter.

In the longer term, despite having a good surgical outcome and being urinary continent once again, the artificial urinary sphincter may need to be replaced with another one after 8 to 10 years due to the device reaching the end of its expected lifespan.

What happens during the recovery period?

In summary, patients are asked to rest for a few weeks following surgery to allow everything to heal. During this period, the artificial urinary sphincter remains deactivated. There’s nothing to be particularly done during the recovery period, apart from not over exerting oneself.

Once things have healed, patients are seen around six weeks after surgery to activate (switch on) the artificial urinary sphincter.

What are the alternatives to artificial urinary sphincter surgery?

There are some alternatives.

If patients don’t wish to have an operation, stress urinary incontinence can be managed on a very simple level with the use of pads or capture devices such as a convene, a catheter, or special types of underwear.

Secondly, there are peri-urethral injections, although typically these don’t work as well as other options and very often have short-lived effects.

Thirdly, there is a device called a male sling, which is a piece of mesh that is inserted into the perineum and put onto the urethra. The sling is then pulled tight to increase the pressure on the urethra to increase resistance to outflow. Unfortunately, the success rates of this more simpler device is not as good as the artificial urinary sphincter. In cases where 90 per cent of patients fitted with an artificial urinary sphincter will be down to zero or one pad a day, the same measure for patients using a male sling is around 70 per cent.

If you are in need, or are considering, artificial urinary sphincter surgery and you would like to consult your options with an expert, don’t hesitate to book an appointment with Mr Rowland Rees via his Top Doctors profile today.