Background

The artificial urinary sphincter consists of a cuff, control pump and balloon reservoir which are pressure-regulating. The AUS effects urinary incontinence by an incompressible ring that restricts urethra through pumping and refilling process with a valve.  

The AUS procedure is a surgical intervention that is performed globally to relieve substantially severe urinary incontinence in women with 10 years survival. The average life span of those who underwent the transabdominal approach is 10 years with bladder neck placement.  

Indications

AUS would be a good option for patients with stress incontinence because of a decreasing functioning of the sphincteric after the prostate surgery who have not respond adequately to conservative management . Careful assessment of patient, including motivated patient, ability to self-catheter, and age, is necessarily done for high success. AUS can be implemented for patients over 80 years old, considering the allowance for the factors such as psychological acceptance, and fidelity to the routine treatments, which are more complicated by the existing higher risk of infection and erosion.  

Contraindications

AUS approach would not be suitable for individuals who cannot endure general anesthesia or may undergo surgical complications and those who have had previously placed urethral sling.  

Risk is involved for the AUS when the patients have cognitive dysfunction or poor manipulative function. If the patients have incontinence based on lower urinary tract obstruction, detrusor hyperreflexia, or bladder instability.  

Outcomes

Equipment

The equipment includes nonabsorbable polypropylene ties, disposable syringes, containers, antibiotic solution, urinary sphincter kit, barbecue clamps, catheters, contrast solution, skin dressings, electrocautery, hegar dilators, scissors, penrose drain, retracts, sponge bowl, saline, and umbilical bandage.  

Surgical Instrumеnts  

Patient preparation

Before the surgery the patient has to go through an in-depth urinary investigation both when it comes to medical history and physical examination, with the patient’s voiding diaries, antibiotic treatment (in case of positive urine culture) and preoperative urine culture.  

Patients before inserting AUS must do cystoscopy to examine the urethra and rule out deformation. For all patients, the antibiotic agents are indispensable which must be administered before the procedure.  

Dust and lint tend to accumulate on the silicon, so disinfect components in sterile saline, and carefully rinse the surgical gloves too before use to prevent contamination of silicone.  

Artificial Urinary Sphincter placement

Step:1- Incision and Exposure: To do that, make a vertical midline perineal incision with a scalpel and delicate dissecting tools in order to free the urethra and the subcutaneous tissues. Make sure you pick out corporal bodies, perform sharp dissection in order to uncover bulbar urethra, implement retractors, and put a Penrose drain or vessel loos around the urethra.  

Step: 2 – Cuff Placement: The cuff size should be flat around the urethra confirming the dissection. Size variations are from 3.5-11 cm, with 4 cm for men and 6-8 cm for ladies. Place the cuff, push the implant (adversely facing the outside) through the channel, and draw the cuff tubing through the hole, then toughen the assembly on the urethra securely. Press the tab on the longitudinal side of the tubing connector.  

Step: 3 – Reservoir placement: The pressure-regulating balloon is put on the pump’s side, that is opened with the help of sharp dissection and electrocautery, and external oblique or rectus fascia found. Pass two transverse 2-0 polydioxanone sutures on fascia to outline transverse incision location and close it at the end. With a 15-blade scalpel, perform a tiny transverse cut.  

Step: 4 – pump placement: Get a knife and put an incision then insert the pump with the button that pushes it facing the skin after which put in two tubing sets one for the pump and the other for the balloon reservoir that regulates pressure.  

Step: 5 – Tubing placement and testing: It is important to place the tubing at the pelvic bone in a position where it is close but not causing any discomfort. Put in the tubing via tool. Attach the proximal perineal tubing, remove the tubing and re-shoe it, assemble the tool and shod the fingers.  

Step:6 – Closure: Incision should be irrigated with saline or antibiotic solution and perineal and abdominal cuts should be closed with absorbable sutures, then skin should be covered with dry sterile dressing.

Artificial Urinary Sphincter Placement

Complications

The postoperative complications occurred after the AUS placement are an absence of liquid inside the device, urethral tissue atrophy, erosion, infection, the requirement of another surgery, no change in the quality of life, and lower urinary tract symptoms such as urgency or stress urinary incontinence, frequency, and nocturia. Gross hematuria, dysuria, and troubles with urination can appear due to an infection or an erosion or malfunction of the device and have different experience symptoms.  

References

Artificial urinary sphincter – PMC  

Artificial Urinary Sphincters and Adjustable Dual-Balloon Continence Therapy in Men – StatPearls     

References

Artificial urinary sphincter – PMC  

Artificial Urinary Sphincters and Adjustable Dual-Balloon Continence Therapy in Men – StatPearls