Placement of an artificial urinary sphincter

Indications

When an artificial urinary sphincter is proposed:

• Severe to major urinary incontinence after prostate surgery (radical prostatectomy), or after prostate interventions, if pelvic floor re-education is not sufficient.
  
• Significant stress urinary leakage, or copious leakage (often >300-500 mL/24h) depending on the case.
  
• Patient’s ability to manipulate the hand-controlled pump (skill, dexterity, understanding) to trigger micturition.
  
• Sterile urine, no urinary tract infection at the time of surgery.
  
• Favourable skin condition, good healing expected, no major antecedents that contraindicate the procedure (e.g. chronic infection, healing problems).
  

Surgical technique & procedure

Here is a typical procedure for artificial sphincter placement:

1️⃣ Pre-operation preparation

• Clinical assessment: urodynamics, flowmetry, assessment of post-micturition residual, urethral examination (endoscopy) to rule out any obstruction.
  
• Urinalysis to ensure absence of infection.
  
• Information and consent, explanation of the device, handling and post-operative procedures.
  
  

2️⃣ Surgery

• Anaesthesia: general or regional, depending on the patient.
  
• Incisions: often one at the perineum, one at the inguinal fold or in the abdominal region, depending on the type of sphincter used. Sometimes via the scrotal route in men.
  
• Place the cuff around the urethra, position the reservoir balloon and pump. The components are connected and the system is closed.
  
• The sphincter is left deactivated for the healing period (often several weeks) before being put into service.
  

3️⃣ Hospitalization and aftercare

• Usually short-term hospitalization (a few days) for monitoring.
  
• Post-op urinary catheterization, pain management, local care.
  
• Sphincter activation phase after healing, often around 4 to 6 weeks.