ATOMS Male Sphincter

Item Number: 37381, 37387, 36812

Male Stress incontinence/ Incontinence
Usually after a TURP/TUVP, Radical Prostatectomy in 2% of cases as pre-described complication of surgery

Pre-requirements

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.

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!

What next?

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.