Use of the artificial sphincter in the treatment of urinary incontinence.

Data analysis of my experience with the implantation of the artificial sphincter shows an overall success rate of 84%. These results are in 139 females ranging from 5 to 84 years of age. The surgery is difficult primarily because the urethral-vaginal septum is not a surgical plane. Even partial injury to these tissues can lead to failure with erosion of the device into the urethra or vagina. The use of a new surgical instrument, the 'cutter clamp' (Figure 8A-F), is expected to improve results because of the precision it offers in dissecting around the bladder neck. Infection occurred in four out of 139, or 3% of the cases. In one infected case, the cuff eroded into the urethra. The infection rate may actually be higher since infection might account for some of the other erosions which occurred. Once erosion occurs, secondary infection can obscure the fact that the device was contaminated at the time of the original implantation. The use of a surgical isolation bubble system may lower both the incidence of infection and erosions in the future. The relief to the totally incontinent female by the artificial sphincter cannot be overestimated. The patients are very grateful, especially since most have undergone multiple treatment methods in an effort to cure their incontinence. The effectiveness of the device, barring infection or erosion, is evident by a success of 91% of such patients being socially continent and 66% being completely dry.