Everyone has a pelvic floor: it is a hammock of muscles that lies in your pelvis, supporting the organs (bowel, bladder, and – in women – the uterus) in that area and keeping them in the correct place. In your pelvic floor are a few muscles that are called “sphincters”. There is an internal and external sphincter surrounding the urethra (the tube that takes urine from the bladder out of your body). These urinary sphincters naturally contract around the urethra and keep urine inside your body until you relax the sphincters at a socially-acceptable time (generally when you’re using a toilet). As the urge to urinate increases, you can voluntarily increase the contraction of your sphincters to gain more control.Surgery to implant an artificial sphincter involves placing an inflatable cuff around the bladder neck above the pelvic floor. In men, the cuff can also be placed below the pelvic floor in the bulb of the urethra (just behind the base of the scrotum). A pump (placed inside the body in the labia or scrotum) is used to deflate the cuff, allowing urine to pass through at the appropriate time for passing urine. The fluid pumped from the cuff goes into the third component of the device, which is an elasticized reservoir balloon; this slowly returns the fluid to the cuff, so it automatically refills after a couple of minutes, once again closing off the urethra.
Men or women with stress incontinence following sphincter damage may be interested in this surgery. Sphincter damage can occur as the result of prostate surgery, episiotomy, or childbirth. People with neurological disease affecting sphincter function may also consider artificial urinary sphincter placement.
This surgery provides a possible treatment option for those who have experienced sphincter damage. As with any surgery, there are certain risks associated, especially the risk of infection. There is also a risk of tissue erosion at the site of the implant. Not everyone is cured with this treatment.
Medical Reviewer: Marcus Drake, M.D.
Marcus Drake, MD, He is the Senior Lecturer at University of Bristol and a visiting Professor at the University of the West of England; member of the first organizing committee for “Innovating for Continence: The Engineering Challenge” conference; member of the basic science committees of the third International Consultation on Incontinence (ICI), and is Chairman of International Continence Society Standardisation Committee. Dr. Drake’s specialist interests are in Female and Reconstructive Urology, Neurourology and Urodynamics.