UROLOGICAL SURGERY
AMS 800 artificial sphincter
Placement of AMS 800 Artificial Sphincter for post-prostatectomy urinary incontinence
The AMS 800 device is used for the treatment of urinary incontinence due to a resistance to urine outflow in the urethra/bladder (intrinsic sphincter deficiency) in male, female and pediatric patients.
Complete urinary incontinence , i.e. the involuntary loss of urine, is a problem that can affect, among others, about 2% of patients who undergo surgery on the prostate.
Urinary incontinence often seriously compromises the quality of patients in various areas: social, psychological, professional, domestic, physical, sexual, but it can be treated effectively thanks to surgery. According to data published by various authors, the placement of an artificial sphincter for sphincter insufficiency allows satisfactory continence to be obtained in most cases, considerably improving the patient’s overall quality of life.
The alternative treatment, represented by the chronic and daily use of external aids (diapers, collection systems, condoms) certainly does not guarantee a good quality of life.
Any intake of antiplatelet action drugs (Aspirinetta, Ascriptin, Ibustrin, Plavix, Ticlopidine, Tiklid, or similar) or anticoagulant drugs (Coumadin, Sintrom, or similar), must be strictly suspended before the operation under the supervision of the GP, and eventually replaced with low molecular weight heparin-based therapy.
The positioning of the AMS 800 type artificial sphincter involves a series of clinical and instrumental checks, to be performed before hospitalization, including: blood tests, urine test with urine culture, PAD test/wet diaper weight, urethrocystoscopy, complete urodynamic exam and possible ultrasound of the urinary tract and retrograde and voiding cystourethrography.
OUTLINE OF SURGICAL TECHNIQUE
USEFUL TIPS FOR DISCHARGE
Convalescence
It lasts an average of 10 days. Starting from discharge, normal daily activities can be gradually resumed, provided that too violent efforts or lifting objects weighing more than 2-3 kilos are avoided.
Sports activity and sexual activity
They can be resumed 30 days after the operation, and in any case, always after the follow-up visit.
The wound
The stitches of the abdominal skin wound can be removed approximately 8 days after the operation, during the first check-up visit. In some patients a skin suture can be performed with an intradermal technique and it is not necessary to remove any sutures. The stitches of the scrotal wound will reabsorb on their own, within about 15-20 days, without the need for any removal.
You can take a shower starting 2 days after the stitches are removed (bathing in the tub is allowed about 20 days after the operation).
Device infections
The symptoms can be varied. However, the most common are represented by severe pain in the abdomen and/or in the scrotum (especially in the testicles), fever, any secretions from the penis. In case you suspect a sphincter infection, it is advisable to carry out a check-up visit to the General Practitioner or go to an Emergency Department. In some cases, a new hospitalization may be necessary.
Urinary tract infections
The percentage of occurrence of urinary tract infections during convalescence is equal to about 3%, according to literature data. For this reason, in order to avoid them, an antibiotic treatment is administered for the period of convalescence. In the suspicion of a urinary tract infection, it is advisable to perform a complete urine test and a urine culture with antibiogram and ask the attending physician to set up any appropriate antibiotic therapy.
Abdominal pain
Normally, post-operative pains are minimal, related to skin wounds, and easily controllable with a common analgesic treatment.
Need for reoperation
A reoperation may be necessary in the following cases:+
– If an infection occurs at the site of the sphincter implant
– If a malfunction of the sphincter or even just one of its components becomes evident.
Reoperation has the purpose of removing the entire device or one of its components (replacing them).
In case of infection, once the sphincter has been removed, the tissues will be abundantly sprayed with antibiotic solution and any infected collections will be drained outside.
It will absolutely not be possible to implant a new device during the same surgery, in order to avoid problems of superimposed infection. A new operation will be possible once the infection has adequately resolved.
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Florence | Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 – Florence (FI)
Telephone: 055 570224
Florence Castello | Villa Donatello
Via Attilio Ragionieri, 101
50019 – Sesto Fiorentino (FI)
Telephone: 055 50975
Prato | Studi Medici Life
Viale della Repubblica, 141
59100 – Prato (PO)
Telephone: 0574 583501
Milan | Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 – Milan (MI)
Telephone: 02 480801
Dr. Andrea Cocci
urologist and andrologist
The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.
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