Urinary Sphincter Replacement

What you should know

  • Urinary sphincter replacement is surgery to replace your urinary sphincter with an artificial urinary sphincter (AUS). The urinary sphincter is a 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 AUS keeps urine from leaking when your urinary sphincter no longer works as it should.

  • 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 relaxes the cuff and allows urine to flow out of your bladder.

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

  • You may bleed more than expected or get an infection. You may have trouble urinating after the surgery. Your urethra, bladder, or nearby tissues may be damaged. Women may have bruising or damage to the labia or vagina. Men may have bruising or damage to the scrotum. 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 may break down or the tubing may become blocked. The AUS may not work and you may continue to leak urine. You may need another surgery to fix or replace the AUS.

  • Without 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. Urine leakage can interfere with your daily life.

Getting Ready

Before your surgery:

  • Write down the correct date, time, and location of your surgery.

  • Arrange a ride home. Ask a family member or friend to drive you home after your surgery or procedure. Do not drive yourself home.

  • 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.

  • You may need blood or urine tests. You may also need an MRI or cystoscopy. Talk to your caregiver about these or other tests you may need. Write down the date, time, and location for each test.

  • 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.

The night before your surgery:

Ask caregivers about directions for eating and drinking.

The day of your surgery:

  • Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for 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.

  • 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.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

  • A sample of your urine will be tested to check for a urinary tract infection.

Treatment

What will happen:

  • An incision will be made to reach your urethra. For men, the incision will be made in the scrotum or perineum. The perineum is the area between the penis and anus. For women, the incision will be made in the abdomen or vagina. Your surgeon will measure your urethra to choose the correct AUS cuff size. He 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 surgeon will check the pump to see that it works properly, and then he will turn the pump off. Your incisions will be stitched closed and covered with bandages.

After your surgery:

You will be taken to a room to rest until you are fully awake. Caregivers will monitor you closely for any problems. Do not get out of bed until your caregiver says it is okay. When your caregiver sees that you are okay, you will be able to go home or be taken to your hospital room.

Contact a caregiver if

  • You cannot make it to your surgery.

  • You have a fever.

  • You get a cold or the flu.

  • You have questions or concerns about your surgery.

Seek Care Immediately if

  • Your symptoms get worse.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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