Artificial Urinary Sphincter Procedure in Madanapalle

An artificial urinary sphincter (AUS) is an inflatable, man-made device used instead of a urinary sphincter. Sphincters in the urinary system are muscles that help your body hold in urine. Artificial urinary sphincter surgery has been the standard treatment for severe urinary incontinence in men since the 1970s. Urinary incontinence is a medical term that refers to involuntary (not under our control) urine leaks. Mild urinary incontinence can be managed through conservative methods like controlling fluid intake or practicing pelvic floor strengthening exercises. But severe urinary incontinence that does not respond to conservative methods requires surgical intervention.
 

An artificial urinary sphincter (AUS) is a medical device commonly used in severe urinary incontinence that mimics your urinary sphincter's function. Urinary incontinence is the inability to hold urine due to damage or defect in your urinary sphincters. This most often occurs due to the following causes:

• Congenital (present before birth in the mother's womb) abnormalities 
• High-impact injury
• Genitourinary surgery (surgical aspects of the urinary tract)

An artificial urinary sphincter (AUS) device consists of a:

• Cuff- It is filled with fluid that wraps around your urethra (a tube that carries urine out of your body) and helps control the urine flow. 
• Pump- This is placed in the scrotum (pouch-like sac of skin that holds your testicles) and moves the fluid into or away from the cuff.
• Balloon in the abdomen- This is the part of the AUS where the fluid is moved to when the cuff is open or deflated.

There are two types of AUS:

• The AUS with a balloon reservoir (3-component) consisting of a cuff, balloon, and pump.
• The AUS with a spring (2-component) consisting of a cuff and a pump unit. 

The most common aspect of the urinary continence mechanism is your body's urethral sphincter. Any injury or weakening of this sphincter may lead to urinary incontinence that is differentiated into three stages, namely:

• Stage I- Light incontinence with urine loss of 10g/24 hours
• Stage II- Moderate incontinence with urine loss of 11 to 50g/24 hours
• Stage III- Severe incontinence with urine loss of over 50g/24 hours.

An Artificial urinary sphincter (AUS) is often recommended in complete male urinary incontinence due to irreversible sphincter weakness or injury. 
The most common indications of an artificial urinary sphincter include:

• Post-prostatectomy incontinence- Men who experience urinary incontinence post radical (complete) prostatectomy (removal of the prostate gland).
• Post benign prostate surgery- Incontinence that may occur post laser surgery for benign (non-cancerous) lesions.
• Post urethroplasty incontinence- Incontinence that occurs after a pelvic fracture urethral injury.
• Neurogenic bladders- Bladder incontinence that occurs with normal motor and sensory function. 
   

When you notice any symptoms of urinary incontinence (like urine leakage while laughing, coughing or sneezing, uncontrollable urge to urinate, or frequent urination), visit a surgical urologist or a urogynecologists. Urologists are doctors that specialize in the diagnosis and treatment of diseases of the urinary tract. Urogynecologists are doctors specializing in reconstructive surgeries for pelvic floor disorders.

Medical history

• Discuss your symptoms with your urologist to evaluate the stage and severity of urinary incontinence.
• You must discuss with your urologist about other medical conditions being suffered that may include asthma, thyroid, and bleeding disorders, diabetes (increased blood sugar levels), high blood pressure (hypertension), or other heart and lung-related diseases. 
• Always inform your urologist about your medications, such as blood thinners, anti-inflammatory, anti-hypertensive, antidepressant drugs, or other herbal supplements. 

Physical examination

• Your urologist will conduct a thorough physical examination of your abdomen and pelvic area to check for any lump or abnormal mass to rule out other pathologies.

Diagnostic tests

• Complete urinalysis and culture sensitivity test to rule out urinary tract infections (UTI). 
• Serum PSA is done to check for prostate-specific antigen (PSA), especially for post-radical prostatectomy.
• Cystoscopy (a test to look inside the bladder using a cystoscope with a tiny camera) to rule out any bladder contracture and other ureteral pathologies.
• Urodynamics to assess the bladder capacity and rule out bladder pathologies that may cause device failure post-procedure.
• Pressure flow study to evaluate the pressure inside the bladder and the urine flow rate.
• Voiding cystourethrography is performed to inject a radio-opaque dye into the bladder, and the urine flow is evaluated through X-ray images. 

Preparation

• You must take antibiotics if your urine samples show traces of microorganisms, indicating urinary infection. 
• You must discontinue the medications taken at least 2 to 3 weeks before the AUS placement, as instructed by your surgeon.
• You should quit smoking and alcohol intake at least two weeks before the procedure.
• You must fast 6 to 8 hours before AUS placement since it is done under general anesthesia (a numbing agent). This helps to prevent aspiration of food particles into the lungs.
• You must arrange for someone to drive you home after the procedure.
• Be sure to sign a consent form to give permission to the operating surgeon. 
• You must come to the procedure in loose, comfortable clothes. Refrain from wearing any jewelry on the day of the surgery. 

AUS placement is an outpatient procedure, which means you can go home the same day. It is usually performed under general anesthesia (a type of anesthesia that puts you to sleep), which may take around 2 to 3 hours. 

Here is what will happen during AUS placement:

• Your nurse will monitor your vitals (blood pressure, sugar levels, pulse, heart rate, and urine output).
• Your bladder will be emptied completely, and your surgeon will insert a catheter to make sure the bladder is empty during the surgery.
• An intravenous (IV) line will begin administering the anesthesia, fluids, and antibiotics (if needed). 
• Once asleep, your surgeon will make an incision (3 to 4 cm long) in the space:
  • Between your scrotum and anus for men.
  • Between your labia and anus, for women.
• Your surgeon will make another small incision in your lower abdomen. 
• The surgeon will fit the AUS device in the desired position.
• The cuff of the AUS device will be left open by your surgeon until it is activated a few weeks later. 
• Your surgeon will then close the incisions with stitches. 

When you wake up, you can expect mild pain and discomfort that may resolve gradually over a period of time. 

• You will most likely be sent home the same day or advised to stay in the hospital for a day or two, depending on your individual condition. 
• The surgeon may remove the urinary the same day or leave it for a few more days. 
• Your surgeon will prescribe painkillers that help ease your pain and discomfort once you return home.
• Instructions given by your surgeon have to be followed for 4 to 6 weeks post-procedure:
  • Do not lift heavy objects.
  • Avoid strenuous exercises and activities.
  • Drink at least 1 to 2 liters of water every day.
  • Avoid saunas, swimming, and tub baths instead of showers.
  • To prevent constipation, consume a high-fiber diet (fruits, vegetables, and whole grains).
  • Avoid vaginal penetration.
  • Do not smoke or consume alcohol.
• You must visit your surgeon after six weeks to activate the AUS device.
• Complete recovery may take up to 6 to 8 weeks. 

AUS surgery or placement is the most effective long-term treatment for severe urinary incontinence, especially in men. 

Benefits 

The benefits of the procedure include:

• Improves your quality of life
• Saves you from social embarrassment due to urinary leakage
• Provides long-term relief from symptoms
• A successful method to treat stress urinary incontinence, which occurs during activities like coughing, laughing, lifting, or sneezing

Risks

The most common complication of an AUS procedure is urinary retention, which means the inability to empty the bladder fully. Other risks may include:

• Device malfunction
• Infection around the AUS placement
• Hematuria, the presence of blood in the urine
• Urethral tears
• Allergic reactions to anesthesia cause hives, skin rash, itching, nausea, confusion, and breathing difficulties.
• Loss of bladder control
• Thinning of the muscle mass (muscle wasting) in the urinary tract
• Frequent urinary tract infections (UTIs)
• Risk of hematoma (collection of blood), and seroma- (accumulation of fluid)

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