Type of Surgery
Information
Last updated: 02/17/2009
Artificial urinary sphincter surgery
Milder forms of urinary incompetence can be treated with changes in diet, evaluation of medications, and the use of antidepressants and estrogen replacement, as well as bladder training and pelvic...
muscle strengthening. However, sphincter deficiency, unlike incontinence caused by urethral mobility, requires a substitute for the sphincter contraction by implant or by auxiliary tissue. If AUS cannot treat sphincter deficiency, the sling or "hammock" procedure is a good second choice. It brings tightness to the sphincter by using tissue under the urethra to increase contractual function. The sling procedure is already preferred over the AUS for women.
Artificial anal sphincter surgery
Milder forms of fecal incontinence are being treated by changes in diet and the use of certain bowel-binding medications. For some forms of mild fecal incontinence, special forms of exercise can help to strengthen and tone the pelvic floor muscles, along with providing biofeedback to train the muscles to work with an appropriate schedule. Only after these measures have been tried, including the use of pads, is the patient counseled on the benefits of an anal sphincter implant.
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Definition
Artificial sphincter insertion surgery is the implantation of an artificial valve in the genitourinary tract or in the anal canal to restore continence and psychological well being to individuals with urinary or anal sphincter insufficiency that leads to severe urinary or fecal incontinence.
Purpose
This procedure is useful for adults and children who have severe incontinence due to lack of muscle contraction by either the urethral sphincter or the bowel sphincter. The primary work of the lower urinary tract and the colon is the storage of urine and waste, respectively, until such time as the expulsion of urine or feces is appropriate. These holding and expelling functions in each system require a delicate balance of tension and relaxation of muscles, especially those related to conscious control of the act of urination or defecation through the valve-like sphincter in each system. Both types of incontinence have mechanical causes related to reservoir adequacy and sphincter, or "gatekeeper" control, as well as mixed etiologies in the chemistry, neurology, and psychology of human makeup. The simplest bases of incontinence lie in the mechanical components of reservoir mobility and sphincter muscle tone. These two factors receive the most surgical attention for both urinary and fecal incontinence.
From http://www.answers.com/topic/artificial-sphincter-insertion
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As a urologist, I've found it's easier to do the PSA test and then sit down with the patient and say here's what the results mean for you. Given what we know right now, that seems a very sensible approach.
-Dr. Evan Vapnek
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