Artificial Compression Devices (Balloon insertion)

Artificial compression devices, also known as balloons, are a common treatment for mild to moderate SUI. They compress the urethra just below the bladder neck so that it can better resist the pressure of a full bladder. The goal of the balloons is to reduce urine leakage during activities such as sneezing, coughing, running or lifting.

When should I consider a balloon insertion?

Balloons can be considered in case of mild to moderate urinary incontinence. They are also recommended when other surgical treatments are not possible, or if you do not want to undergo major surgery.

How are balloons inserted?

The artificial compression device consists of a balloon which can hold fluid, a small titanium port, and a tube that connects the port to the balloon. The port allows the doctor to regulate the amount of fluid in the balloon. Two balloons are inserted on either side of the urethra during a minimally-invasive procedure.
For the procedure you usually receive general anaesthesia, but in some cases you may be recommended spinal anaesthesia. First the doctor inserts a catheter to make sure that your bladder is completely empty during the surgery.
The doctor then makes an incision in the perineum. Using x-ray for guidance, the doctor places the first balloon on one side of the urethra, under the prostate. If you have had radical prostatectomy, the doctor places the balloon right under the bladder neck. This is then repeated with the second balloon on the other side of the urethra (Fig. 1).
Finally the doctor positions the titanium ports in the scrotum and connects them to the balloons. This is done so that the volume of the balloons can easily be adjusted after surgery.

How do I prepare for the procedure?

Before the surgery the doctor will ask for a urine sample to make sure you do not have a urinary tract infection. If you have an infection, your doctor will prescribe antibiotics before, during, and after the operation.

Your doctor will advise you in detail about how to prepare for the procedure. You must not eat, drink, or smoke for 6 hours before surgery to prepare for the anaesthesia. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Your doctor will advise you on when you can start taking it again.

How long will it take me to get back to my daily activities?

The doctor will generally remove the catheter immediately after the surgery and monitor your recovery. Usually you can leave the hospital a few days after the procedure. If you have problems urinating or there is much post void residual urine in the bladder, you may have to stay longer. The recommended length of hospital stay varies in different countries.

After any surgery, your body needs time to fully recover. It can take up to 6 weeks for the wound to heal completely. During this time you may experience pain in the pelvic area, or feel pain when you urinate. Your doctor can prescribe medication to deal with these symptoms.

Recommendations for 4-6 weeks after the surgery:

Drink 1-2 litres every day, especially water
Do not lift anything heavier than 5 kilograms
Do not do any heavy exercise
Take showers instead of baths
Avoid thermal baths, or going to the sauna
Adapt your diet to prevent constipation

You need to go to your doctor or go back to the hospital right away if you:

Develop a fever
Are unable to urinate on your own
Have heavy blood loss or pain
Have significant blood in the urine
Notice the wound starts to bleed or leak transparent fluid, or it hurts

Advantages
The volume of the balloons can be adjusted
Chance of improvement of stress urinary incontinence

Disadvantages
Risk of injury to the urethra or the bladder during surgery
Very low risk of injury to the bowel or blood vessels in the pelvic area
Risk of temporary urinary retention
Risk of urgency urinary incontinence
Risk of bruising or bleeding in the abdomen
Risk of urinary tract infection
Risk of erosion of the device leading to infection of the bladder, rectum or urethra
Risk of recurrence of urinary incontinence
Risk of needing another surgery in case the device is not effective