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Vocabulary :

Artificial Urinary Sphincter -  is the only device that closely simulates the function of a biological urinary sphincter.

AMS 800 artificial urinary sphincter -  is the most commonly used device and is the criterion standard for the treatment of incontinence caused by intrinsic sphincteric dysfunction. It is composed of a pressure-regulating balloon, an inflatable cuff, and a control pump. The balloon has a dual function as a pressure regulator and a fluid reservoir.

Postprostatectomy Incontinence -  which is the most common indication for placement of an artificial urinary sphincter after a prostate cancer treatment

Intrinsic Sphincteric -  dysfunction following pelvic fracture, spinal cord injury, or urethral reconstruction.

Neurogenic Sphincter -  with associated sphincter or bladder neck incompetence.

Recurrent disease -   (eg, stone disease, bladder or ureteral tumors) that requires retrograde endoscopic instrumentation is a relative contraindication. Such instrumentation can predispose to cuff erosion in patients with an artificial urinary sphincter.

Inflatable Cuff – part of AUS which fits snuggly around the urethra and compresses the urethra except during voiding. The cuff applies pressure to the urethra to keep it closed.

The Pump -  which is placed inside the scrotum and controls the deflation of the cuff. It facilitates transfer of fluid to and from the cuff.

The Fluid Reservoir (balloon) –  part of AUS which is implanted in an inguinal incision and controls the amount of pressure exerted by the cuff.

ARTIFICIAL URINARY SPHINCTER

The artificial urinary sphincter is considered an alternative to urinary diversion. Artificial sphincter insertion surgery is the implantation of an artificial valve in the genitourinary tract or in the anal canal to restore continence and psychological well being to individuals with urinary or anal sphincter insufficiency that leads to severe urinary or fecal incontinence.

Since complications have the potential to occur, this is a treatment technique that generally is reserved for people for whom all other treatment options have failed. This includes conditions that result in the removal of the sphincter. Sphincter deficiency can result directly from pelvic fracture; urethral reconstruction; prostate surgeries; spinal cord injury; neurogenic bladder conditions that include sphincter dysfunction; and some congenital conditions.

However, the use of AUS with women has declined with advances in the use of the sub-urethral sling due to its useful “hammock” effect on the sphincter and its high rates of continence success. Women with neurologenic incontinence can benefit from the AUS.

Procedure

The artificial urinary sphincter is made of a silicone rubber material. The surgical process consists of a doctor placing a small balloon in the lower abdomen, an inflatable cuff around the urethra, and a pump in the scrotum.

When the cuff accumulates fluid it compresses the urethra so that urine will not be released. Patients simply squeeze the pump a few times when they want to urinate. Once the pump is activated the fluid flows from the cuff to the balloon.All fluid will flow into the cuff after urination is completed. Similar to most minor surgical procedures, there is a slight risk of bleeding or infection.

Some doctors have reported cases where patients have experienced urinary retention and a malfunction or breakage of the device.

The artificial urinary sphincter is not suitable for older men, for men who have undergone radiation therapy, or for those who have vascular disease.

Three Components of The Artificial Urinary Sphincter (AUS)

1) The Inflatable Cuff - which fits snuggly around the urethra and compresses the urethra except during voiding. The cuff applies pressure to the urethra to keep it closed.

2) The Pump - which is placed inside the scrotum and controls the deflation of the cuff. It facilitates transfer of fluid to and from the cuff.

3) The Fluid Reservoir (balloon) - which is implanted in an inguinal incision and controls the amount of pressure exerted by the cuff.

The three parts are connected by tubing and filled with saline solution or a contrast medium. When a man wants to urinate, he squeezes the pump 2 to 3 times until is it completely dimpled, which pulls fluid out of the cuff releasing the pressure around the urethra. The man voids and then in 3-5 minutes the cuff automatically reinflates.

To empty the bladder, squeeze and release the pump, located in the scrotum. This moves the fluid out of the cuff and into the pressure-regulating balloon. Because the empty cuff is no longer pressing the urethra closed, the urine can flow out from the bladder.

Several minutes after the bladder is empty, the fluid automatically returns from the pressure-regulating balloon to the cuff, once again squeezing the urethra closed.

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