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Artificial Urinary Sphincter Insertion
What is
Artificial Urinary Sphincter Insertion?
Artificial sphincter insertion surgery utilizes
an artificial valve implanted in the
genitourinary tract in order to re-establish
continence and the psychological well-being of
patients suffering from an inefficient urinary
sphincter which results to urinary incontinence
that is severe.
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Effects
of Artificial Urinary Sphincter Insertion
This
procedure is a reliable and effective treatment
for men, as well as women suffering from
intrinsic deficiency of the sphincter or
weakness of the muscles of the sphincter.
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Candidates for Artificial Urinary Sphincter
Insertion
Both
adults and children suffering from severe
incontinence because of lack of muscle
contraction of the urethral sphincter may
benefit from this procedure.
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Your Consultation
The major form
of surgery in this procedure is open surgery for
the placement of the implant. Preoperative
sterilization of the urine, as well as
preoperative bowel preparation are done so as to
minimize the occurrence of infection.
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The
Artificial Urinary Sphincter Insertion Procedure
With
general anesthesia, the pelvic space is entered
from the abdomen or from the vagina. At the site
of the small incisions for the device,
broad-spectrum antibiotics are provided
intravenously. The urinary catheter is then put
in place and the cuff is implanted surrounding
the neck of the bladder and held and passed
through the rectus muscle and anterior fascia
which is then to be connected afterward to the
pump. To keep the balloon in the pubic area, a
space is created. The pump is then placed in a
pouch underneath the abdomen. Only after six to
eight weeks will the artificial urinary
sphincter is activated to permit healing after
undergoing the procedure. The patient will then
be taught on how to use the device and is made
to understand that the cuff continues to be
inflated in its "resting state" and maintains
the urethra closed by pressure, therefore,
allowing continence. When the patient wants to
urinate, he or she can press the pump in order
to temporarily deflate the cuff. The urethra
then opens and results in emptying of the
bladder. The cuff closes automatically.
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Recovery
After
undergoing the procedure, it is necessary that
the patient undergo a few days of
hospitalization. Administration of both oral and
intravenous pain medications are done together
with some postoperative antibiotics. On the
evening of the surgery, a general diet is
usually available. The urethral catheter can be
removed once the patient is able to ambulate.
Usually, patients may be discharged on the
second postop day unless other procedures are
done or if extra time for recovery is warranted.
Approximately six weeks after the procedure is
done, patients are not allowed to have any
strenuous activities or lift heavy objects. The
patient returns in order to train for the use of
the implant device six to eight weeks after the
procedure.
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Risks
One of
the risks that may be encountered in this
procedure is failure of the implant. When the
device fails or if the cuff erodes, repeat
surgery is imperative. Another is urinary
voiding. Postoperative edema occurs because of
bruising of the tissues that leads to difficulty
in urinating. In most of the cases, urination
resumes when the swelling has subsided. Finally,
infection is another recurrent and serious
complication of this procedure not only because
of the infection itself but also because it can
cause erosion of the urethra or the bladder neck
below the implant which could actually worsen
the incontinence.
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Frequently Asked Questions
Q:
What are the causes of urinary incontinence?
A:
Most cases of urinary incontinence are caused by
issues related primarily to the tone of the
pelvic, urethral, and sphincter muscles. They
are usually related to leakage when stress is
put to the abdominal muscles through coughing,
sneezing, or exercising. Stress incontinence is
a result of reduction in the competence of the
sphincter to maintain the bladder to be closed
during movement. It can also be related to the
urethra's mobility and spilling of urine caused
by its tilting. Urge incontinence on the other
hand is related to overactivity of the sphincter
also known as sphincter hyperflexia. What
happens is the sphincter contracts
uncontrollably which causes the patient to
urinate a lot of times in a day. Another is
urinary incontinence. This is due to a urethra
that is inadequately small resulting in overflow
of the urine and is also known as overflow
incontinence. Augmentation of the urethra in
order to increase its size can be done in order
to treat this problem.
Q:
Who is affected with urinary incontinence?
A:
According to studies and research, approximately
13 million adults are affected by urinary
incontinence. This is more common in women than
in men over the age of 65 with rates of almost
50%. Prostate problems and its treatment are
the most common causes of incontinence in older
men. Three to six months after a radical
prostatectomy, incontinence is a complication
which affects majority of male patients. After
artificial urinary sphincter resection is done,
most men recover and regain continence. In 1-5%
of male patients, stress incontinence happens
after the standard treatment for severe benign
prostatic hyperplasia.
Q:
What is artificial urinary sphincter?
A:
The artificial urinary sphincter or AUS is a
small apparatus situated beneath the skin
keeping pressure on the urethra until the
patient decides to urinate wherein a pump
permits the urethra to open and urination
begins.
Q:
What are the alternatives to this procedure?
A:
Besides undergoing this procedure, there are
several alternatives for the patient to try
before opting for surgery. Dietary changes,
evaluation of medications, use of
antidepressants and estrogen replacement, as
well as bladder training and pelvic muscle
strengthening can be utilized. On the other
hand, if the problem is sphincter deficiency,
this requires a substitute for the sphincter
contraction by implant or by auxiliary tissue.
An alternative for AUS if it cannot solve the
problem of sphincter deficiency would be the
sling or "hammock" procedure. This results in
tightness of the sphincter by using tissue
beneath the urethra in order to result in an
increase in its function of contraction. As a
matter of fact, the sling procedure is actually
chosen over the AUS by most women.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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