Artificial Sphincter (Urinary Retention Mechanism) Surgery

Artificial sphincter application should be performed with the deterioration of the functions that serve to hold urine. These mechanisms help to maintain urine retention by artificial means. So what is the artificial sphincter, how is it applied and what should be considered before the surgery?

Urine is formed in the kidneys and stored in the bladder. The bladder that reaches a certain capacity needs to be emptied, so the bladder that reaches the appropriate level stimulates the brain and ensures that the urine is expelled from the body through the urethra channel. In humans, there are two mechanisms in the urinary canal called the sphincter, which are used to hold urine. The first of these structures work automatically, that is, involuntarily. and allows the body to hold its own urine. The first sphincter automatically closes when urine is emptied. The sphincter located below helps people to hold their urine by squeezing and voluntarily. Thanks to these innate mechanisms, it is possible to hold the urine and throw it out when the time comes.

However, in some people, these two mechanisms cannot function at the same time, and due to this situation, urinary incontinence occurs. If even one of the two sphincter structures is intact, it helps to urinate in a controlled manner. If both sphincter mechanisms are damaged, urinary incontinence develops. This problem greatly harms the social life of the person and negatively affects his psychology. The method used to eliminate the problem is called artificial sphincter application.

An artificial sphincter is applied to patients whose sphincter mechanisms do not work as expected and who encounter urinary incontinence. Sphincter is the name given to the double annular muscle mechanism that is used to hold urine with its contraction and relaxation properties. The artificial sphincter is a system that mimics this mechanism and eliminates the problem of urinary incontinence. The artificial sphincter has 3 parts. These are called sphincter tank, urinary canal ring, and pump that provide on-off control.

Urination in patients with artificial sphincters is achieved by using these parts. The patient squeezes the pump while urinating and closes the ring channel in the urinary canal by squeezing. Thus, the urine is sent to the sphincter reservoir and the urinary canal is relaxed and opened. At the end of this procedure, the patient urinates and closes the channel again by pressing the pump. The size and diameter of the ring in the urinary canal are calculated with special tools so that the patient has the most ideal artificial mechanism.

Urinary incontinence can be treated with different surgical techniques and medication. Artificial sphincter surgery is usually performed when other treatment methods have not worked. Artificial sphincter surgery may be considered in male and female patients who continue to have urinary incontinence. If there is stenosis or damage in the urethra for any reason, these problems should be eliminated before sphincter surgery.

Apart from this, artificial sphincter surgery can be applied in the following cases:

• Damage to the bladder nerves and incomplete storage and evacuation processes in the bladder
• urinary tract injuries
• Urinary duct rupture as a result of pelvic fractures
• Damage to the urinary tract in urethra surgeries
• Continuation of urinary incontinence problem in patients undergoing prostate surgery

There are some issues that patients who will undergo artificial sphincter surgery should pay attention to. First of all, patients who have had this surgery and have an artificial sphincter inserted can use this mechanism approximately 4-8 weeks after the surgery. Because it takes a certain time for the artificial mechanism to adapt to the body, and the adaptation process differs for each patient. The adaptive artificial sphincter builds a nest and is ready for use.

The artificial sphincter is a synthetic material and has the risk of inflammation, so the hygiene of the application area should be ensured before the operation. For this, the patient ensures that the area remains clean by using special antibiotics and solutions before the operation. In addition, the hair in the genital area should be shaved regularly and the area should be kept clean. However, this application is made by the doctor and the area is cleared of existing hair.

Artificial sphincter surgery can be applied with different incision methods according to the patient’s condition and the doctor’s recommendation. In women, it is most advantageous to make a horizontal incision about 5-6 cm above the pubis bone. This does not require a second incision and ensures minimal surgical scarring. In men, an incision can be made at the junction of the penis and scrotum.

Before the surgery, a catheter is inserted into the urinary canal and a large part of the urine is entered. With special measuring devices, the diameter of the duct is calculated and the size of the ring to be installed is decided in this way.