[Intestinal implantation of an artificial sphincter]

Area of Science:

• Urology
• Colorectal Surgery
• Biomedical Engineering

Background:

• Restoring anal sphincteric function and creating continent urinary reservoirs are significant challenges in reconstructive surgery.
• The artificial bowel sphincter (AMS) system, comprising a peri-intestinal cuff, pump, and pressure-regulating balloon, offers a potential solution.
• Similar principles can be applied to construct continent valves for intestinal segments used in bladder reconstruction.

Observation:

• Two patients with fecal incontinence secondary to high imperforate anus syndrome underwent AMS implantation.
• One patient achieved daytime continence (degree 2), and the second achieved both daytime and nighttime continence after over a year of follow-up.
• An artificial valve was implanted in seven patients undergoing neobladder reconstruction, with successful outcomes in four cases and failure in three.

Findings:

• The AMS system demonstrated efficacy in restoring anal continence in patients with complex fecal incontinence.
• Artificial valves integrated into neobladders showed a success rate of approximately 57% in achieving urinary continence.
• The device's components allow for adjustable pressure and volume, crucial for functional restoration.

Implications:

• This technology holds potential for improving quality of life in patients with fecal incontinence and those requiring bladder reconstruction.
• Further investigation and larger trials are warranted to optimize the artificial valve's design and implantation techniques.
• The study highlights the versatility of the AMS system in addressing functional deficits in both the lower urinary and gastrointestinal tracts.