An artificial sphincter - also known as an artificial sphincter - is used to treat severe forms of urinary incontinence. The therapy has a high success rate. For example, 75 to 90 percent of patients are continent after the implantation of an artificial sphincter.
Below you will find further information and specialists for the implantation of an artificial sphincter.
Urinary incontinence is a storage disorder of the bladder. Those affected cannot control their bladder or can only do so partially. In technical terms, they suffer from involuntary leakage of urine.
10 to 40 percent of women and 3 to 11 percent of men suffer from urinary incontinence in the course of their lives. Demographic trends with increasing life expectancy mean that these figures will rise significantly in the near future.
Healthy people can voluntarily control their bladder from the age of 5. However, if urinary incontinence occurs, it is a symptom of a disease. Those affected should have themselves examined, as the problem can usually be treated.
The causes are different in children and adults, men and women. The diagnostic examination depends on
individually. Childhood urinary incontinence will not be discussed further in this article.
Stress urinary incontinence is characterized by involuntary urine leakage under stress. Stresses are, for example
Even walking or, in the worst case, lying down can be enough to cause loss of bladder control.
This is caused by a loss of sphincter function.
In men, prostate surgery is often responsible. Stress urinary incontinence is particularly common after complete removal of the prostate(radical prostatectomy).
In women, stress urinary incontinence is the result of, among other things
Around 50 percent of urinary incontinence in women between the ages of 20 and 60 is stress-related.
With urge urinary incontinence, the patient is unable to hold back urine when the bladder fills up. Pathophysiologically, the bladder muscle builds up such high pressure that the patient can no longer hold back urine voluntarily.
Urge urinary incontinence is a common symptom of urinary tract infections.
It occurs more frequently with increasing age due to the remodeling of the bladder wall with decreasing elasticity. The frequency is up to 70 percent in over 70-year-olds.
In mixed urge and stress urinary incontinence, both forms of urinary incontinence occur side by side.
Illustration of different forms of urinary incontinence © bilderzwerg | AdobeStock
A thorough diagnosis is a prerequisite for successful treatment. The doctor must identify the form of incontinence and its cause.
First, the doctor takes a medical history and asks questions about urinary incontinence, urination, drinking and bowel movement behavior. Other important aspects of the medical history are
This is followed by a physical examination. This is followed by the creation of a micturition log in which you
over several days.
Depending on the suspected diagnosis, the doctor will carry out further examinations. These often include
Various forms of treatment are available for women and men with stress urinary incontinence.
In the early stages of stress urinary incontinence and for milder forms, pelvic floor training is recommended. Strengthened pelvic floor muscles often provide effective relief for urinary incontinence - even in men. You can benefit from a few uncomplicated exercises every day without having to consult a doctor.
Medication usually proves to be less helpful. They can be administered in tablet form or injected into the sphincter muscle. They only work for a short time, if at all.
A permanent solution to the problem can be achieved with various surgical treatment methods:
The optimal treatment method is selected depending on
Thegold standard for severe stress incontinence is the artificial sphincter. It has been implanted in constantly modified and improved form since around 1980.
The artificial sphincter consists of three functional units. They are connected to each other by a system of tubes:
The cuff is filled with water and closes the urethra with pressure.
In order to urinate, the patient uses the pump placed in the scrotum or labia. It actively transports the water from the cuff into the reservoir. This allows urine to flow out of the bladder through the urethra.
At the end of urination, the water flows back out of the reservoir into the cuff and thus closes the urethra.
The cuff is implanted either through an incision in the perineum or through an incision in the scrotum. If access is via the scrotum, the valve and reservoir can also be inserted via this incision.
The valve is implanted into the subcutaneous tissue of the scrotum so that it is easily palpable. The reservoir is placed either behind the pubic bone or in the abdominal cavity.
After implantation, the system remains deactivated for 6 weeks to allow the wounds to heal. During this time, urinary incontinence remains.
After healing, the system is activated by the implanting doctor.
In women, the system is implanted in a similar way to men. However, a lower abdominal incision is always necessary to access the urethra.
The pump is usually placed in the labia majora.
As with all other surgical procedures, wound infection poses a certain risk. The infection rate is between 2 and 10 percent, depending on the clinic performing the operation. In the event of a wound infection, the implanted system must be removed.
Another risk is tissue atrophy of the urethra. The permanent pressure of the cuff can cause the tissue to regress. In just under 9 percent of patients, stress urinary incontinence recurs over the years.
In extreme cases, the cuff can also damage the urethra to such an extent that the system has to be removed.
Every material ages, including that of the sphincter system. Therefore, after years, 8 to 24 percent of patients experience a loss of function of the sphincter. The system then has to be replaced with a new one.
Despite all these problems, patient satisfaction rates are very high. Up to 95% of patients with an artificial bladder sphincter are satisfied with the result.
After implantation of an artificial sphincter, 75 to 90 percent of patients are continent. Continent means that a maximum of one urination per day is required. This means that the results are better than any other therapeutic means of treating stress urinary incontinence.
The treatment of stress urinary incontinence is characterized by surgical forms of therapy. In women and men with less severe degrees of incontinence, ligamentoplasty is the first choice.
An artificial sphincter is only used for severe forms of incontinence.
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