Artificial urinary sphincter in men

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrookes. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

The artificial urinary sphincter consists of three components. One part is a circular cuff that is placed around the waterpipe (urethra). This cuff is connected to a small pump that sits in the scrotum and also connected to small fluid filled balloon that sits in the abdominal wall.

What are the alternatives to this procedure

Incontinence into a pad, a urethral catheter or a male sling.

What should I expect before the procedure

You will usually be admitted on the same day as your surgery. You will normally undergo pre-assessment on the day of your clinic or an appointment for pre-assessment will be made from clinic to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel , ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post operatively.

You will have a small incision in the area between the scrotum and anus (the perineum) and the cuff will be placed around the waterpipe. A separate incision will be made in the groin. Through this second wound, the pump will be placed in the scrotum and the balloon placed in the abdominal wall.

What happens immediately after the procedure?

You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise as soon as you are comfortable to prevent blood clots forming in your legs. You will be given antibiotics through your vein (intravenously). You will usually be discharged the day after your surgery.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

☐ Blood in the urine, and temporary stinging when you urinate after the procedure
☐ In the long term, mechanical failure of the device

Occasional (between one in 10 and one in 50)

☐ Urine infection
☐ Wound infection
☐ Temporary insertion of a bladder catheter
☐ Later failure of the device as the cuff becomes lose around the waterpipe (urethral atrophy)
☐ In the long term, infection of the device requiring removal

Rare (less than one in 50)

☐ Erosion of the waterpipe through the waterpipe (urethra)

What should I do when I get home?

The device will be deactivated when you are discharged. You will be reviewed in clinic or on the ward at six weeks after discharge, when the device will be activated (by pressing a button on the pump within the scrotum).

What else should I look out for?

Men who undergo surgery in the perineum (between the anus and the scrotum) may find it easier to sit with their weight shifted onto your one buttock.

You may find it more comfortable to sit using an air filled donut, soft cushion or another type of pillow, especially for the first four weeks after surgery. Any activity that requires you to straddle anything, such as riding a bicycle, motorcycle or a horse should be avoided for four to six weeks.

Are there any other important points?

You will be reviewed in the Outpatients Department. It is likely you will be asked to complete a questionnaire on your symptoms.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery.

You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one-to-one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team may need to remove hair to allow them to see or reach your skin. If the healthcare team consider it is important to remove the hair, they will do this by using an electric hair clipper, with a single-use disposable head, on the day of the surgery. Please do not shave the hair yourself, or use a razor for hair removal, as this can increase the risk of infection to the site of the operation. If you have any questions, please ask the healthcare team who will be happy to discuss this with you.

References

National Institute for Health and Care Excellence (NICE) clinical guideline No 74: Surgical site infection (October 2008)
Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)

Is there any research being carried out in this field at Addenbrooke's?

All operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist 01223 586748
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG) 01223 274608
Prostate cancer nurse practitioner 01223 274608 or 01223 216897 or bleep 154-548
Surgical care practitioner 01223 348590 or 01223 256157 or bleep 154-351

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients) 01223 274608 or 01223 586748 or bleep 157-237
Urology nurse practitioner (stoma care) 01223 349800
Urology nurse practitioner (stone disease) 01223 349800 or bleep 152-879

Patient Advice and Liaison Service (PALS)

PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
01223 216756
Email PALS

Chaplaincy and multi faith community

The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
01223 217769
Email the chaplaincy

Other contact information

PatientLine: *801 (from patient bedside telephones only)

MINICOM system ('type' system for the hard of hearing) 01223 217589

Access Office (travel, parking and security information) 01223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please download and sign the print copy below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or nurse specialist know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

Signature…………………………….…………… Date…………….………………….