The urinary sphincter is a muscle that allows the body to hold urine. Normally, the sphincter remains contracted until the person decides to relax it to urinate. When a person has difficulty controlling the urinary sphincter, they may experience involuntary urine leakage.

When this occurs, the implantation of an artificial urinary sphincter is a second-line treatment to eliminate stress urinary incontinence . It is recommended in cases of severe incontinence or when the placement of a mesh or sling has not resolved the problem.

It is a long-term, durable solution for both female and male urinary incontinence , but for implantation, it is important that the patient be able to manually control the device . The doctor will perform an examination to ensure there are no contraindications for its placement.

The artificial urinary sphincter consists of three parts:

• A sleeveIt is a silicone ring that fits around the urethra. When the cuff is inflated (filled with fluid), it puts pressure on the urethra and contracts it to block the flow of urine. When you need to urinate, the cuff deflates (empties of fluid) and reduces the pressure on the urethra to allow urine to flow out.
• A balloonIt contains a small amount of saline solution and regulates the pressure in the cuff. The fluid moves into it when the cuff is deflated.
• A pumpwhich causes the fluid to enter or exit the cuff. In the case of women, the pump mechanism is placed on the labia of the vulva, and in the case of men, on the scrotum.

To use the artificial sphincter, when a patient needs to urinate, they must squeeze the pump placed on the scrotum (in men) or vulva (in women). The pump forces fluid out of the cuff and into the balloon, deflating the cuff and opening the urethra. The cuff remains open for one minute for urination. It then closes automatically.

What does the artificial urinary sphincter operation involve?

For the implantation of an artificial urinary sphincter in men, the surgeon will make two small incisions under general or epidural anesthesia: one in the scrotum, where the cuff will be placed, and another near the lower abdomen. In women, the procedure is usually performed laparoscopically or abdominally.

When the surgery is finished, the incisions will be closed with sutures (stitches) that will dissolve on their own without needing to be removed.

Following the operation, the patient will remain hospitalized for 24 hours with a catheter to drain urine. After this time, the patient will be discharged with a series of recommendations provided by the urologist.

The artificial urinary sphincter will not be activated until approximately six weeks have passed, once it has fully healed. Therefore, the patient will continue to experience urinary incontinence during this time. During this period, it is also possible to experience pelvic pain or pain when urinating. Your doctor may prescribe medication to alleviate these symptoms.

During the first week after your surgery, your urologist may recommend wearing a scrotal support and waiting six weeks before resuming strenuous activities such as gym workouts, cycling, or lifting weights heavier than 4 kg (9 lbs). Your doctor will advise you on when you can resume sexual activity.