Artificial sphincter
Above all, the introduction of robot-assisted da Vinci prostate removal for prostate cancer has significantly reduced the number of patients who are incontinent after the operation. If incontinence nevertheless occurs, the insertion of an artificial sphincter in men is a reliable method of regaining control over holding urine. This procedure can be performed in the case of severe incontinence and should take place no earlier than one year after the cancer operation.
Insertion of an artificial sphincter at a glance
| Indication | Stress incontinence after prostate cancer surgery |
| Principle | Insertion of a hydraulically fillable urethral cuff |
| Operating time | approx. 1–2 hours |
| Hospital stay | 5–7 days |
| Note | General anaesthesia recommended |
Questions about the implantation of an artificial sphincter
In certain cases, urinary incontinence occurs in connection with prostate cancer surgery. Fortunately, the number of patients who are incontinent after the operation has fallen significantly, because the use of the da Vinci surgical robot for prostate cancer generally enables satisfactory continence. If incontinence nevertheless occurs, the insertion of an artificial sphincter in men is a reliable method of regaining control over holding urine. This procedure can be performed in the case of severe incontinence and should take place no earlier than one year after the cancer operation.
Access to the urethra is created in the area of the perineum. The urethra is encircled with a cuff that can be filled hydraulically. A reservoir is placed in the lower abdomen via a small incision, and a small pump is placed in the area of the scrotum. The correct placement and functionality of the artificial sphincter are monitored during and after the operation.
The implanted pump is operated by pressing it with the fingers. This empties the urethral cuff and you can urinate. The fluid pumped into the reservoir in the meantime flows back on its own after a few minutes and refills the cuff, so that the urethra is sealed again.
In addition to the general risks of any operation, such as bleeding, inflammation and impaired wound healing, there are special risks with this operation. As with any foreign body implantation, there is a risk of infection, which may mean that the prosthesis has to be removed again. The cuff can also grow into the urethra. All possible risks of the surgical procedure are discussed in a detailed consultation before the operation.
Patients are admitted for the operation on the day of surgery. The surgical procedure takes about 1 to 2 hours. The operation is followed by an inpatient stay of 5–7 days.
It is advisable not to work for 1–2 weeks after discharge and to take it easy physically. After 6 weeks, the artificial sphincter can be activated and the patient is instructed in how to use it. Until then, the incontinence initially persists.
The prospects of long-term satisfactory continence after the operation are very good. The artificial sphincter only has to be replaced if complications occur in subsequent years.
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Incontinence after prostate surgery?
Is an artificial sphincter the solution?
Here you will find everything important about the artificial sphincter: when it is used, how it works and how the operation is performed. Also: who it is suitable for, what components there are and what patients should bear in mind.
- Used for stress incontinence due to insufficient sphincter function
- Components: silicone cuff around the urethra, reservoir in the abdominal cavity, pump in the scrotum (in women in the outer labia).
- Procedure: implantation via one or more small incisions, cuff below the pelvic floor, reservoir in the lower abdominal cavity, pump palpable in the scrotum.
- Mode of operation: the cuff keeps the urethra closed, overpressure controlled by fluid in the reservoir, bladder emptying by operating the pump.
- Goal: restoration of continence and significant improvement in quality of life in severe stress incontinence.
About this page:
Author
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
