53447 Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

Name of the Procedure:

Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

Summary

This procedure involves the removal of an existing inflatable artificial urinary sphincter apparatus, which includes the pump, reservoir, and cuff. It is followed by the implantation of a new, similar device in a single surgical session to maintain urinary continence.

Purpose

The primary goal of the procedure is to address urinary incontinence due to a malfunctioning or ineffective artificially implanted urinary sphincter. By replacing the defective components, the patient regains better control over urinary function, thereby improving quality of life.

Indications

• Persistent urinary incontinence due to malfunctioning or failed artificial sphincter.
• Mechanical failure of the device components (pump, reservoir, or cuff).
• Pain, infection, or erosion related to the current device.
• Sphincter device-related complications such as urethral atrophy.

Preparation

• Patients may be required to fast for 8 hours before the procedure.
• Adjustments to regular medications, particularly blood thinners, as advised by the physician.
• Preoperative diagnostic tests such as urine culture, blood tests, and imaging studies to assess device positioning and function.

Procedure Description

1. Anesthesia: The patient is administered general or regional anesthesia.
2. Incision: A small incision is made in the perineal area (for the cuff) and another in the lower abdomen (for the pump and reservoir).
3. Removal: The surgeon carefully excises the existing pump, reservoir, and cuff.
4. Placement: New components that match the patient's anatomical and functional requirements are then inserted.
   • The cuff is placed around the urethra or bladder neck.
   • The pump is positioned in the scrotum or labia.
   • The reservoir is implanted in the abdominal wall.
5. Connection: All parts are connected and tested to ensure proper functioning.
6. Closure: Incisions are closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically lasts between 1.5 to 3 hours.

Setting

The procedure is performed in a hospital operating room or specialized surgical center.

Personnel

• Urologic surgeon
• Anesthesiologist
• Operating room nurses
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Device malfunction or mechanical failure
• Urethral or bladder injury
• Pain or discomfort at the surgical site
• Erosion or migration of the device
• Need for future revisions or replacements

Benefits

• Improved urinary continence
• Enhanced quality of life and daily functioning
• Immediate improvement in urinary control usually noticed within a few weeks after surgery

Recovery

• Hospital stay of 1-2 days post-surgery
• Pain management with medications
• Instructions for wound care and activity limitations
• Follow-up visits for device adjustments and monitoring
• Full recovery and optimal functioning of the new device typically within 6-8 weeks

Alternatives

• Behavioral therapies and pelvic floor exercises
• Medications to manage symptoms
• Use of external urinary collection devices
• Other surgical options, such as a sling procedure or different types of sphincter implants
• Each alternative varies in effectiveness, invasiveness, and recovery time.

Patient Experience

• Patients may feel discomfort or pain at the incision sites post-surgery, managed with medications.
• Swelling and bruising are common but typically resolve within a few weeks.
• Gradual improvement in urinary control can be expected, with most patients returning to daily activities within a few weeks.
• Follow-up visits are crucial for ensuring the device is functioning correctly and making any necessary adjustments.