Urinary Sphincter Replacement

What you should know

• Urinary sphincter replacement is surgery to replace your urinary sphincter with an artificial urinary sphincter. Your urinary sphincter is a strong muscle that surrounds your urethra. Your urethra is a tube that carries urine from your bladder to outside your body. Your urinary sphincter squeezes your urethra to keep urine in your bladder until it is time to urinate. An artificial urinary sphincter (AUS) may be needed if your urinary sphincter is weak or damaged. A weak urinary sphincter may cause urinary incontinence. When you have urinary incontinence, you cannot always control when you urinate, and you may leak urine. Women may need an AUS if other treatments for urinary incontinence fail. Men may have urinary incontinence after prostate surgery and need an AUS.
  
  
• An AUS may be needed to stop urine leakage caused by radiation therapy. You may need an AUS after a spinal cord injury if you cannot control when you urinate. An AUS device has a balloon reservoir , a cuff, and a pump that connect together. When your AUS is turned on, liquid inside the balloon flows into the cuff. When the cuff is filled, it squeezes your urethra and prevents urine from leaking out of your bladder. To urinate, you press the pump, which causes liquid to leave the cuff and fill the balloon. The cuff stops squeezing your urethra and allows urine to flow out of your body. After a few minutes, the liquid flows back into the cuff on its own, blocking urine from leaking out. Having an AUS placed may help you control when you urinate and stop your urinary incontinence.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• During surgery, your urethra, bladder, bowel, or nearby tissues and organs may be damaged. Females may have bruising or damage to the labia or vagina. Males may have bruising or damage to the scrotum. After surgery, you may get an infection in or around your wound , urethra, or AUS. If your AUS becomes infected, it may need to be removed. Your urethra may be damaged by the pressure from the AUS cuff. The cuff on the AUS may break down, and the tubing may become blocked. The AUS may not work, and you may still leak urine, or your urine leakage may get worse. You may need another surgery to fix or replace the AUS.
  
  
• If you do not have surgery, your urine leakage may get worse. You may leak larger amounts of urine, more often. The urine may cause your skin to become red and sore. Not being able to control when you urinate can interfere with your daily life. Talk with your caregiver if you have questions or concerns about your surgery, condition, or care.

Getting Ready

Before your surgery:

• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Tell your caregiver if you have high blood pressure or heart disease. Also tell your caregiver if you have had radiation therapy or urinary sphincter replacement before.
  
  
• Your caregiver will check your hand movement to make sure you can use the AUS pump correctly. If you are a woman, your caregiver will do a vaginal exam. Your caregiver may ask you to write down when you leak urine in a diary. You will need to write down how often you leak urine and how much you are leaking.
  
  
• You may meet with a caregiver to talk about what to expect after your surgery. The caregiver will show you how to use the AUS, and you will practice using the AUS device. Talk with your caregiver about any questions or concerns you have about getting, and using, an AUS.
  
  
• You may need blood and urine tests, urodynamic testing, magnetic resonance imaging (MRI), and a cystoscopy. Your caregiver may have you do a standing cough test to see how much urine you are leaking. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• A sample of your urine will be tested to check for a urinary tract infection.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• You may be given antibiotic medicine to help prevent an infection caused by germs called bacteria. You may be given antibiotic medicine before, during, and after your surgery.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the surgery room and moved to a table or bed. You will be given general anesthesia to keep you asleep and free from pain during surgery. Your abdomen and the area between your legs will be shaved and cleaned. A catheter may be put in your urethra, so your caregiver can feel the urethra easily. An incision will be made to reach your urethra. For men, the cut will be made in the scrotum or perineum. The perineum is the area between the penis and anus . For women, the cut will be made in the abdomen or vagina.
  
  
• Once the cut is made to reach your urethra, the catheter is removed. Your caregiver will measure your urethra to choose the correct AUS cuff size. Your caregiver will place the AUS cuff around your urethra. A small cut may be made in your lower abdomen to place the balloon reservoir. For some men, the entire surgery may be done through the cut in the scrotum. Tubing connected to the balloon reservoir is tunneled through your abdomen to reach the AUS pump.
  
  
• For men, the AUS pump will be placed in the scrotum. Tubing from the cuff is often tunneled down into the scrotum. For women, the pump is placed in the labia through a small cut. The labia are skin folds found on each side of the vagina. Tubing from the cuff and the balloon reservoir will be connected to the pump in the scrotum or labia. Your caregiver will check the pump to see that it works properly, and then turns the pump off. Your cuts will be stitched closed and covered with bandages.

After your surgery:

• You will be taken to a room to rest until you are awake. Caregivers will watch you to make sure you are not having any problems. You may have a catheter in your bladder to drain your urine into a bag. Do not get out of bed until your caregiver says it is okay. Once caregivers see that you are not having any problems, you may be taken back to your room.
  
  
• Your AUS will not be turned on for 6 to 8 weeks after surgery to let the area to heal. You will continue to leak urine during this time. Wearing a pad will help absorb leaking urine until the AUS is turned on by your caregiver.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You are late or cannot make it to your surgery.
  
  
• You have a fever.
  
  
• You feel pain when you urinate.