ATOMS Male Sphincter
Item Number: 37381, 37387, 36812
Why is it done?
- Male Stress incontinence/ Incontinence
- Usually after a TURP/TUVP, Radical Prostatectomy in 2% of cases as pre-described complication of surgery
- Informed consent is required from the patient and a pre-admission clinic will be arranged.
- Patients may not eat or drink from midnight the previous evening.
- Patients are to refrain from smoking before the procedure.
- Patients allergic to IODINE/CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr. Schoeman.
- Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. This may be replaced by once-daily Clexane injections.
- Pre-operative blood tests are required 4 days prior to surgery.
- Patients with cardiac illnesses require a cardiologist/ physician report.
- A chest X-ray is required for patients with lung disease.
- Be prepared for a 2-night stay.
How is it done?
- Anaesthetic, as decided by the anaesthetist.
- The legs will be elevated into the lithotomy position.
- A 7cm incision is made on the perineum (space between scrotum and anus).
- The silicone inflatable cushion is placed anterior to the upper end of the corpora cavernosa of the penis.
- The arms of the device are curled around the inferior rami of the pubic bone.
- The device is placed with pressure on the CC
- This tensioning can be done under cystoscopic vision.
- The access port is placed in the scrotum
- The pad is inflated with carefully determined volume
- The wounds are closed with dissolvable sutures and/or skin glue.
- A local anaesthetic is given for pain relief.
- A urinary catheter is placed for 24hrs.
- The catheter will be removed early the next morning.
- The patient’s urine output will be measured each time they urinate and the residual will be measured. (Patients will be required to do this up to 3 times.)
- If the residual amount of urine is more than 1/3 of the total bladder capacity, the patient may have to self-catheterize, until the residual volume is acceptable.
- Prophylactic antibiotics will be given to prevent infection.
- Any anaesthetic has its risks and the anaesthetist will explain all such risks.
- Complications: hemorrhaging, requiring blood transfusion <1%;
- Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for 24 hrs.
- Pelvic pain for 10-14 days may occur, making it difficult to sit.
- If you cannot urinate after 2-3 attempts, the catheter may be replaced and adjustment to sphincter volume will be made
- This may less effective in irradiated patients
- NB! Each person is unique and for this reason, symptoms may vary!
- Patients will have a trial of void without catheter the next day.
- Patients will be discharged as soon as they can completely empty the bladder.
- Adjustments to sphincter pad volumes will be made in 6 weeks.
- Patients may initially suffer from urge incontinence but this will improve within the next 6 weeks.
- Allow 6 weeks for symptoms to stabilise.
- Initial period of pelvic pain is expected.
Copyright 2019 Dr Jo Schoeman