A preliminary report on a new hydraulic sphincter for controlling urinary incontinence.

A new pressure-regulated artificial urinary sphincter (AUS) has been developed which overcomes many of the deficiencies of earlier devices. This implantable AUS comprises a circular occluder cuff and the means to inflate and deflate through a pressure-regulated valve. The device is made from medical-grade silicone rubber and filled with radio-opaque isotonic fluid. A few days before surgery the implant is coated on the outside with an antibiotic-loaded silicone rubber solution. Tests have shown that the regulated pressure was very easily adjusted in situ by injecting or withdrawing the hydraulic fluid through a hypodermic needle penetrating a self-sealing filling port. When set, the regulated pressure remained very stable. The mechanism by which cuff pressure was increased to overcome stress incontinence worked well. Of the five earlier devices (AUS Mk I) implanted, none has survived without mechanical failure. The two latest implants (Mk II), which were rigorously tested for defects before implantation, have been more successful.