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Current Indications for the Use of The Artificial Genitourinary Sphincter and Management of It's Complications

2004; Hindawi Publishing Corporation; Volume: 4; Linguagem: Inglês

10.1100/tsw.2004.57

2356-6140

Daniel S. Elliott, David M. Barrett,

Urinary Bladder and Prostate Research

The first artificial urinary sphincter was implanted in 1972 and since then many advances in product design, improvements of surgical techniques, and proper patient selection have resulted in decreasing complication rates and improved patient satisfaction. The currently used artificial sphincter (AUS) is the American Medical Systems (AMS) 800. This prosthesis consists of silicone components: (1) an elastic pressure-balloon reservoir; (2) a control pump; and (3) an inflatable occlusive urethral cuff. The balloon reservoir is manufactured to hold a volume of fluid which exerts a range of preset pressures (51-60, 6170, 71-80, and 81-90cm water) that can be selected from based on the site of cuff placement and the clinical situation. The pump contains a unidirectional valve, a refill-delay resistor and a deactivation button. This assembly allows for complete control of cuff activation/deactivation by the patient and physician. In the activated mode, the urethral cuff is de-pressurized by squeezing the pump, thereby, forcing fluid from the cuff through the unidirectional valve into the balloon reservoir (Fig. 1). Following a delay period of three to five minutes, time allowed for voiding, fluid automatically flows back to repressurize the cuff. The AMS-800 can be non-surgically deactivated by pressing the deactivation button on the pump which prevents fluid in the balloon from returning to the cuff. Deactivation allows for healing to take place without compression on the urethra. Deactivation also facilitates catheterization, cystoscopy and transurethral resection, if necessary. Activation is accomplished by a sustained squeeze of the pump.