The artificial urinary sphincter: review and progress

Urinary incontinence, the inability to retain urine, creates a misery that cannot be overestimated. The foul odor emanating from the patient repels family and friends to such an extent that it affects the social life of the sufferer. Total incontinence, that is, the continuous loss of urine as opposed to the loss associated with coughing or sneezing, is the most severe type of the malady. For such individuals, the artificial sphincter offers hope for a new life. Incidences of total urinary incontinence as a result of radical prostatectomy in the treatment of carcinoma of the prostate have been reported in the range of 5-50%. Incontinence may occur as a result of injury to the proximal urethra, and it is usually present to some extent in patients with neurogenic bladder dysfunction caused by spinal cord injury, myelomeningocele, or other conditions that affect the micturition centers of the nervous system. Some patients whose urinary tract is completely obstructed and who are therefore unable to urinate, as for example individuals who sustain traumatic complete transection of the urethra with resulting obstructive fibrosis of the urethra, or those patients whose neurogenic spastic sphincter inhibits satisfactory voiding, may benefit from reconstructive surgery or ablation of their pathologic sphincter in order to restore urination. Rehabilitation of such patients can then be complete with implantation of an artificial sphincter to provide urinary control. The alternatives for management include diapers, the placement of external collecting or occlusive devices, or major surgery in which the intestinal tract is used either for conducting the urine to an abdominal collecting bag or as a bladder substitute that is periodically emptied by catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)