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Abdominal approach for implantation of the A.S. 800 artificial urinary sphincter in females
Author(s) -
Light J. Keith
Publication year - 1988
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.1930070610
Subject(s) - medicine , artificial urinary sphincter , surgery , urinary incontinence , sling (weapon) , urodynamic testing , sphincter , urinary system , urology
The artificial urinary sphincter has been used with success in female patients with neuropathic bladder dysfunction and resultant urinary incontinence as the device has reliably substituted for the nonfunctioning sphincteric mechanism in these patients. A combination of augmentation cystoplasty to create a low pressure reservoir with the artificial urinary sphincter was successful in restoring continence in 92% of pediatric patients with meningomyelocele where other measures had failed. Use of the artificial urinary sphincter in patients with severe, recurrent stress incontinence is likewise highly successful in restoring continence. The potential disadvantage to the sling procedure of having to perform prolonged self‐intermittent catheterization is avoided. Careful preoperative urodynamic evaluation is essential, however, to ensure that a stable bladder with no outlet obstruction is present. The abdominal approach to insert the artificial urinary sphincter avoids the potential of vaginal contamination with subsequent device infection. The operative technique to successfully accomplish this is fully described. The vascularity of the trigonovaginal septum is crucial for success with this approach. Conditions such as previous radiotherapy and excessive atrophy adversely affect the ultimate success of the operation because of decreased tissue perfusion. This applies whether the vaginal or abdominal approach is used to insert the device. Careful attention to preoperative evaluation and surgical technique will result in a high degree of success.