Definition:
consists in the removal of the entire artificial sphincter device or one or more of its components.
Indications:
it is used when there is an infection in the site of the sphincter or an erosion of the tissues inside the its cuff or when the device is malfunctioning in one or more of its components.
The occurrence, although less frequent than in the past, can be seen in 30-40% for system revisions and in 8-13% for complete removal of this. The major risk factors are intraoperative lesions of the vaginal and / or bladder wall.
Description of the technique:
access is conditioned by the need to remove the whole device or just one of its components: in this second case it is more targeted and less invasive. The tissues must in any case be abundantly sprayed with an antibiotic solution; in case of removal due to infectious complications, the collections must be adequately drained outside. Conducts that see the implant of a new sphincter where one was removed for problems of aforementioned infection are absolutely proscribed.
Preparation for intervention:
antibiotic prophylaxis; adequate and accurate disinfection of the skin.
Duration of the intervention:
variable, in relation to the difficulties imposed by the intraoperative context. The substitutions of a single component other than the cuff are easier.
Type of anesthesia:
general, if it is necessary to intervene also within the peritoneum, or peripheral.
Type and duration of hospitalization:
hardly executable in Day-Surgery; predictable 3-4 days of hospitalization.
Results:
the same as for a first system if there are the conditions for a simple replacement of a single component; the final result is also at greater risk if erosions of the internal tissues of the cuff have occurred or if there has been a problem linked to additional infection.
Complications:
in case of infections the septic state should be feared, favored also by the placement of the tank inside the peritoneum. The appearance of a urethrocutaneous fistula due to erosion phenomena cannot be excluded. There is also evidence in the literature of the high probability that a reimplantation, carried out at a later time but always in the same place, leads to a recurrence of the erosion of the internal tissues of the cuff. As for the revisions, these are to be considered very probable as more time passes from the first system implant. If great progress has been made in preventing trivial kinking of the connection ways (the tubes are currently “armed”), there is still the risk of a blockage or loss in the pump and / or tank system, or the need to increase the closing pressure at the level of the cuff.
Attention at discharge:
continue antibiotic therapy according to medical prescription. Refer to the urologist for any eventuality.
Checks:
Checks are advised on a case-by-case basis in relation to what is found and achieved with the surgery.