A new operation for insertion of the artificial urinary sphincter.

A new operation for implantation of the artificial urinary sphincter for total urinary incontinence in women is described. The procedure is done through the vestibule of the vagina with clear exposure of the vesical neck and urethra anteriorly, and easier accessibility for dissection of the vagina from the posterior wall of the vesical neck and upper urethra. This approach reduces the incidence of occlusive cuff erosion and eliminates the chance of shifting of the device. The model AS 800 artificial sphincter was implanted for the first time in 4 patients with total urinary incontinence. Primary deactivation was used and the patients practiced nocturnal deactivation. Complete post-activation continence was achieved in all 4 patients. Mean followup has been 14 months. This approach is easier and less traumatic to the patient. Hospitalization and postoperative recovery times are markedly reduced. Technically, the method is much simpler to perform, particularly dissection between the vagina and the posterior aspect of the urethra, thereby reducing the operative time and complication rate.