Last updated: 02/17/2009

Artificial urinary sphincter surgery

Patients must be chosen carefully, exhibit isolated sphincter deficiency, and be motivated and able to work with the device and its exigencies. To characterize the condition to be treated and to determine...

outcomes, full clinical, urodynamic, and radiographic evaluations are necessary. The ability to distinguish mobility of the urethra as the cause of incontinence from sphincter insufficiency is difficult, but very important in the decision for surgery. A combination of pelvic examination for urethral hypermobility and a leak-point pressure as measured by coughing or other abdominal straining has been shown to be very effective in identifying the patient who needs the surgical implant. Visual examination of the bladder with a cystoscope is very important in the preoperative evaluation for placement of the sphincter. Urethral and bladder conditions found by the examination should be addressed before implantation. Previous reconstruction or repair of the urethra may prevent implantation of the cuff. In open abdominal surgery, the implant surgery uses preventive infection measures that are very important, including sterilization of the urine preoperatively with antibiotics, the cleansing of the intestines from fecal matter and secretions through laxatives immediately prior to surgery, and antibiotic treatment and vigorous irrigation of the wound sites.

Artificial anal sphincter surgery

Since only a limited number of patients with fecal incontinence would benefit from an artificial sphincter, it is very important that a thorough examination be performed to distinguish the causes of the incontinence. A medical history and physical, as well as documented entries or an incontinence diary are crucial to the diagnosis of fecal incontinence. The physical exam usually includes a visual inspection of the anus and the area lying between the anus and genitals for hemorrhoids, infections, and other conditions. The strength of the sphincter is tested by the doctor probing with a finger to test muscle strength.

Medical tests usually include:

• Anorectal manometry. This is a long tube with a balloon on the end that is inserted in the anus and rectum to measure the tightness of the anal sphincter and the ability to respond to nerve firings.
• Anorectal ultrasonography. This test also includes an insertion of a small instrument into the anus with a video screen that produces sound waves, picturing the rectum and anus.
• X rays. A substance called barium is used to make the rectum walls visible to x ray. This liquid is swallowed by the patient before the test.
• Anal electromyography. This test uses the insertion of tiny needle electrodes into muscles around the anus and tests for nerve damage.