A new type of artificial urinary sphincter has been used for the first time in South Africa at a private hospital in Pretoria to treat men with severe urinary incontinence, the loss of bladder control.
Jacques du Plessis, MD of the Netcare hospital division, announced that the device, a Victo adjustable artificial urinary sphincter, has been surgically implanted in a minimally invasive procedure by a team led by urologist, Dr Johan Venter at Netcare Pretoria East Hospital.
According to du Plessis, Venter urgently requested the technology from local distributors in order to treat a Krugersdorp man who suffered stress incontinence problems. “An artificial urinary sphincter is widely considered the gold standard of treatment for complete urinary incontinence in men who have suffered irreparable damage to the urinary sphincter,” Venter said.
“We were particularly impressed by this new-generation artificial urinary sphincter option, our investigations revealing that it was the best new alternative available globally for cases such as this one. Some of the advantages it offers include that it is easy for patients to use and it does not require further invasive surgeries should it require adjustment in future.”
“The first procedure in South Africa using this new technology was completed successfully two weeks ago. The patient is doing well, having been discharged a day after their procedure. The artificial sphincter is activated after approximately six weeks after implantation, once we are sure the patients have fully healed and accepted the device,” Venter said.
“We will be performing a further procedure using this compact artificial sphincter on a Pretoria man with severe urinary stress incontinence soon and will now be offering it as a standard urinary sphincter replacement option at Netcare Pretoria East Hospital,” he said.
Du Plessis said the new technology was designed to overcome shortcomings identified with older generation devices.
Venter said that the Victo device has a pump that is palpated by the patient when he needs to urinate. This is made of soft silicone that is easy for the patient to operate and serves to deactivate the cuff of the sphincter so the patient can pass urine normally. “The entire device is implanted and it is compact, limiting the size of the foreign object within the body. Among the other characteristics of the technology that we appreciate is that it offers two configurations, the Victo and Victo+, and four cuff sizes are available for each to provide a better fit for each patient’s anatomy, which can vary considerably.
“These cuffs should be less likely to go on to leak in the longer term, and while we have yet to have the benefit of longer term medical studies, it should offer a more sustainable solution to severe urinary stress incontinence in men with damaged than other previous types of artificial sphincters,” Venter said. The Victo+ has a stress relief balloon added to provide occlusion, or pressure, automatically if there are increases in abdominal pressure.
Venter says various factors can potentially cause damage to the urinary sphincter and pelvic floor in men, including on-going bladder or bowel problems, constipation, heavy lifting and can occasionally be a complication of prostatectomy, the surgical removal of the prostate gland to treat cancer.
Dr Erich Bock, director of Netcare’s North East region, says that the new implant is an important development for urinary medicine, enabling improved outcomes for male patients who suffer severe urinary stress incontinence caused by a damaged urinary sphincter. “This brand-new device was only introduced to the international market late in 2016 and by all indications it will be the most sustainable and practical solution, offering appropriate patients a substantially improved quality of life,” said Bock.