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Artificial Sphincter Surgery Surgery in India

Definition

Artificial sphincter insertion surgery is a surgical procedure to implant an artificial valve in the anal canal (or genitourinary tract). This is done to restore bowel continence and help to improve the psychological effects caused by inability to have bowel or urine control. Inefficiency to control the sphincter has severe fecal and urinary incontinence.

What is the aim of an artificial sphincter surgery?

The artificial sphincter surgery is performed on children and adults alike. This is for individuals suffering from excess incontinence caused by lack of muscle control in the bowel sphincter or the urethral sphincter.

• The lower urinary tract and the colon are mainly responsible for storing urine and waste, respectively. This waste is stored till it is time to expel the waste or urine out of the body. There is an intricate method of contracting and relaxing the right muscles for ensuring normal bowel and urine movements. There is a sphincter (valve) in each of these systems that allows controlling the fecal and urinary expulsion from the body.

• There are numerous causes that give rise to urinary or bowel incontinence due to abnormal or damaged sphincters. The condition is mostly caused when the mechanical components required for reservoir mobility and the tone of the sphincter muscles change.

• Surgical treatment is the commonly used treatment for correcting both these conditions.

What is artificial urinary sphincter surgery?

• Urinary incontinence is mainly caused by four factors. All of these are related to the tone of the muscles in the sphincter, urethra and the pelvic muscles. Mostly, leakage of the urine is seen as ‘stress incontinence’ when the person is unable to control the out-flow of urine when there is physical stress applied, such as coughing, sneezing or even laughing loudly at times.

• Stress incontinence is the result of the sphincter muscles losing their adequate power to keep the urine inside when there is no intention of urinating. Stress incontinence is also caused when the mobility of the urethra and the position of the urine reservoir. In case stress incontinence is being caused by urethral inadequacy there is another type of surgical treatment for it.

• Another type of incontinence is the ‘urge incontinence’ type. It is believed to arise as a result of an overactive sphincter (sphincter hyperflexia). This causes the sphincter to contract on its own frequently. This causes leakage of urine, called urge incontinence.

• A rare form of incontinence is the ‘overflow incontinence’. In this, the patient is unable to control the flow of urine due to an abnormally small urethra. The treatment for this type of incontinence involves increasing the length of the urethra mainly.

• Artificial sphincter surgery is best-suited for treating stress incontinence being caused by an inadequate sphincter. This surgical treatment is also helpful in treating sphincter deficiency which is often caused by pelvic fractures, prostate surgeries, urethral reconstruction, neurogenic bladder conditions and spinal cord injuries. Any condition which results in malfunctioning sphincter is benefitted with an artificial sphincter surgery for implant.

• Artificial sphincter implant surgery is also commonly called as ‘artificial sphincter insertion’ or even ‘inflatable sphincter insertion’. The implant, called the AUS (artificial urinary sphincter) is a small device which is fitted under the skin to keep the urethra free from an urge to urinate till the bladder is sufficiently full. When the patient wishes to urinate, a pump allows opening the urethra to urinate.

• AUS implant surgery is one of the advisable treatments for treating urinary incontinence in men being caused by abnormal urethral sphincter functioning. This is also efficient to treat women suffering from intrinsic sphincter deficiency or even weakened sphincter muscles.

What is artificial anal sphincter surgery?

Fecal incontinence is mainly identified as the inability to control the bowel movements due to loss of control over the anal sphincter. This can be caused due to a congenital (birth) defect, Crohn’s disease or other similar colorectal disease, accidents resulting in neurological injuries and by surgical resection for treating localized cancer.

In case the fecal incontinence is severe then the doctor may advise an artificial anal sphincter implant surgery. This surgery aims to implant an efficient implant device which works similarly to a natural anal sphincter by replacing the original malfunctioning anal sphincter.

What is the diagnosis for determining the need for artificial urinary sphincter surgery?

There are several major factors that play an important role in helping the surgeon decide whether a patient is a good candidate for an artificial sphincter surgery. The individual’s medical history is read carefully to determine the underlying condition causing the malfunction of the sphincter. Comprehensive clinical, radiographic and uro-dynamic testing is required.

It is often difficult to identify whether urethral mobility or sphincter inadequacy is the cause of the condition. This requires extensive pelvic exams. This may include a visual examination of the bladder using a cystoscope which also helps to decide the exact spot for placing the artificial sphincter implant. In case any bladder or urethral abnormalities are found, these need to be corrected before the sphincter implant surgery. A prior surgery for repairing or reconstructing the urethra may make implanting the artificial sphincter more challenging.

When this surgery is done using conventional ‘open abdominal’ surgical technique the surgeon will administer sufficient antibiotics to prevent infection. The urine is sterilized effectively using antibiotics and the intestines are cleansed with laxatives before the implant surgery.

What is the diagnosis for determining the need for artificial anal sphincter surgery?

There is a limited portion of the total patients who can benefit from an artificial anal sphincter surgery. This needs careful vetting to determine these patients efficiently. A thorough medical examination can help to determine the cause of the bowel incontinence. Understanding the medical history and the present physical state of the patient helps to understand the condition better.

The patient is encouraged to make documented entries and maintain a diary detailing the frequency and time of bowel movements. These are important to diagnose fecal incontinence. The anus is examined visually for infections, hemorrhoids and other abnormalities. A probing finger can also help the doctor to determine the anal sphincter muscle strength.

These are the commonly performed medical tests required to diagnose the cause and development of fecal incontinence:

• Anorectal manometry – This is performed by using a long tube with an inflatable end. This probe is inserted into the anus and rectum to measure the strength of the anal sphincter. It also helps to check for nerve response in the region.

• Anorectal ultrasonography – This test also requires inserting a small instrument in the anus which has a sound wave emitter at its end. This helps the doctor to use ultrasonograpy technique and get an image of the anus and rectum.

• X-ray test – A contrast x-ray test is done. First, the doctor will inject a small amount of contrasting substance, such as barium, into the rectum walls, which makes them highly visible during a routine x-ray imaging test.

• Anal electromyography – This is useful for testing the functioning ability of the nerve endings in the anus. It involves inserting very small electrode needles into the muscles surrounding the anus.

What are the instructions for post-surgical care after an artificial sphincter surgery?

For artificial urinary sphincter implant surgery

After this surgery, the doctor will usually advise a few days rest in the hospital. Intravenous and oral painkillers are administered with antibiotics to fight pain and prevent infections, respectively. You may be allowed normal diet in the same day as your first meal after the surgery. When you have recovered sufficiently to walk and move around, the doctor will remove the urethral catheter.

Normally, the patient is discharged within a couple of days after the surgery, unless additional procedures were also performed or there is risk of complications in that individual case.

Lifting heavy objects and performing strenuous physical activity will be ill-advised for around 6 weeks after the surgery. Once 6 to 8 weeks have passed since the date of the artificial sphincter implant surgery, the patient will have to return for being trained on how to use the implant device for urinating normally.

For artificial anal sphincter implant surgery

After an artificial anal sphincter implant surgery, the doctor will put you on anti-diarrheal medications and a strict diet to harden the bowels significantly. Antibiotics are also administered to prevent infections. Skin incisions are required to be kept clean. Heavy lifting and strenuous exercise is strictly forbidden for around 6 weeks following the surgery. As the body heals completely over the next 6 to 8 weeks, the patient will have to attend 2 to 3 training sessions and learn the functioning of the new implant devise efficiently.

What are the successful results of artificial sphincter implant surgery like?

For artificial urinary sphincter implant surgery

A risk of failure is present with urinary sphincter implant devices. In case the cuff gets eroded or the device fails to work, a repeat surgery may be required by the patient. Research shows that over 82% of women treated with this surgery are content while around 72% have an ideally functioning original or replacement implant. Around only 37% of these women needed replacement after 7 years.

Research on men concluded similar findings. The malfunction rate in men was around 21% and over 90% of the men treated still have their implanted devices working perfectly.

Urinary voiding may be seen in some case after this implant surgery. A bruised tissue may cause post-operative edema and result in problems with urination. Urination is resumed in most cases as soon as the inflammation subsides. Artificial urinary sphincter surgery is also beneficial for children with the success range being from 62% to over 90%, in boys and girls.

For artificial anal sphincter implant surgery

The success rate of artificial anal sphincter implant surgery has been significantly high for many years. There is a collective failure rate of 5% over two and a half years. This surgery helps to recover adequate anal sphincter functioning in most cases.

It is important to undergo artificial sphincter implant surgery through an experienced and well-trained surgeon, such as those found in India to ensure that the surgery is successful and affordable at the same time.

 

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