Artificial Urinary Sphincter


 

When male patients experience severe urinary leakage, usually wearing several ‘pads’ a day to help manage the leakage, it may be time to discuss an artificial urinary sphincter. Most patients with this type of leakage may have a history of prostate cancer surgery, which can potentially weaken the natural sphincter of the body, causing the loss of normal urinary storage. American Medical Systems is the sole manufacturer and developer of the AMS 800™ Urinary Control System artificial urinary sphincter.

 

How it works?

The AMS 800 artificial urinary sphincter mimics a healthy sphincter in that it keeps the urethra closed until you want to urinate. It does this by automatically moving fluid such as saline (salt and water) through three main components: a cuff, a pump, and a balloon. These components are connected by flexible, kink-resistant tubing.

When you need to urinate, you release the pressure on the urethra so that urine can flow. You do this by simply squeezing and releasing the pump. This action pulls the fluid out of the cuff and sends it to the balloon. Because the empty cuff is no longer pressing the urethra closed, the urine can flow out of the bladder.

Minutes after the bladder is empty, the fluid automatically returns from the balloon to the cuff. Once the cuff is refilled, the urethra is squeezed closed again.

 

Pre-procedure

It is critical that you stop any aspirin, CoumadinⓇ, Plavix, or other blood thinners one week before shockwave lithotripsy. Please call our office should you have any questions about this.

The night before your procedure, you may eat and drink as usual. However, do not take anything by mouth after midnight the night before. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all the prescription and nonprescription medications that you take regularly on the day of the procedure.

Please plan to arrive two hours prior to your treatment.

 

Procedure

Performed under general anesthesia. Two incisions are made. One small incision is made in the soft area below the scrotum and above the rectum, called the perineum. It is in this area that the inflatable cuff around the urethra is placed. A second small incision is made in the right suprapubic area, just around the area one would have a hernia surgery. It is this area we place the fluid reservoir for the system.

The procedure takes approximately 90 minutes, and Dr. Rahul Mehan or Dr. Harpreet Wadhwa will come and speak to your family afterwards.

Upon awakening from the procedure, you will have a catheter draining your bladder. I have yet to meet a man who likes having a catheter, but relax, the catheter typically will remain overnight and then get removed.


Post-procedure

Definitely rest up for a few days after the procedure.

  • For pain, Advil®, Motrin®, or prescription Toradol® work great, dependent upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are nonnarcotic, so you don’t get sleepy, constipated or have other issues; however they are great anti-inflammatories. Take them on a regular basis the first two to three days after the procedure. For pain not relieved by these medications, use the prescription Tylenol® with codeine or Vicodin® that was prescribed for you.
  • Bowels: Do not strain when having a bowel movement. Expect irregular bowel habits until fully recovered. Increase fiber in your diet. You may need a stool softener or laxative. Do not take blood thinners or aspirin products for one week or as directed by your physician.
  • Activity: Take it easy for the first 48 hours after the procedure. Do not drive or operate dangerous equipment for 48 hours following anesthesia. It is important to avoid or reduce strenuous activity for four to six weeks. Light activity the first week after surgery, and then gradually increase it over the next month. Avoid strenuous exercise, heavy lifting greater than 20 pounds, bike riding, and yard work for one month, as the vibrations and movement may cause bleeding. No sexual activity for two weeks after surgery. Wearing tight jockey-type underwear is recommended for at least one week.
  • Catheter: You will briefly need a catheter to drain your bladder, depending upon the extent of your surgery. Wash around the catheter with soap and water and rinse well. You may shower, but avoid baths until the catheter is removed.
  • Diet and fluid: Avoid coffee, tea, carbonated beverages, alcoholic beverages, citrus juices, spicy foods, and smoking for the first month week following surgery. Increase your intake of fluids, particularly water -- 24-48 ounces over your usual daily fluid intake is typically recommended during the first two weeks of your recovery.


Expected signs and symptoms

You may experience swelling or bruising around the incisions, and this is temporary. You may experience some mild burning and discomfort during urination. This is normal and should subside in one to four weeks.


Follow-up

Usually, Drs. Mehan or Wadhwa or their staff will communicate to you a desired follow-up time frame. Please call us the day after the procedure to verify a time to see us in the office. We will plan to activate the artificial urinary sphincter device a few weeks after the swelling has gone down, and show you how to appropriately use the device.


Long term

Time to celebrate! Once your artificial urinary sphincter is activated, you’re on the road to recovery. Just as you won’t run right after knee surgery, have patience as you gradually heal from surgery. Immediately after your device is activated, you will notice that you will be much drier than before. How dry you become is largely dependent on how severe symptoms were prior to surgery. Good news is that you’ll be happy that you chose surgery, just be patient with your road to recovery.