References - Boston Scientific AMS 800 Mode D'emploi

Table 10. Double Cuff Combinations
Cuff
3.5 4.0 4.5 5.0 5.5
Sizes
3.5
    
4.0
    
4.5
    
5.0
    
5.5
    
6.0
    
6.5
    
7.0
    
7.5
  
8.0
  
9.0
  
10.0
  
11.0
 Indicates cuff combinations that may be used.
Place a Second Cuff
1. Deactivate the AMS 800 AUS (see Deactivate Cuff section) and place a Foley
™
catheter or a 20 Fr sound to facilitate urethra identification. The catheter will help
decompress the bladder and help avoid bladder injury during PRB placement.
2. Follow the chosen surgical approach to make an incision and dissect, to expose the
urethra, cuff, and existing clear and black tubing.
3. Clamp the clear and black tubing on each side of the current connectors.
4. Cut the tubing on both sides of the connector(s), between the clamp and the
connector. Remove the cuff if replacing.
5. Determine appropriate cuff size combination.
6. Prepare the cuff(s) as described in the Cuff Preparation, Placement, and Filling section.
7. Implant the cuff(s) with a 1 to 2 cm gap between the cuffs, to prevent them from
rubbing against each other, and to maintain vascularization.
8. Fill the cuff using one of the following methods:
• Flush and fill the new cuff with 1-2 ml of filling solution and re-clamp the cuff, or
• Aspirate all fluid and refill the PRB with 24-26 ml filling solution, then re-clamp
the PRB, or
• Use the cuff pressurization option (see the PRB Preparation, Placement, and
Filling, Cuff Pressurization Option section), and use the Y connector for the
temporary connection.
9. Connect the system using an appropriate connection method: clear cuff tubing to
clear pump tubing, black PRB tubing to black pump tubing.
Note: The short ends of the Y Connector are attached to the cuffs.
Problem What to Do
Total Device
The device fails to cycle. Check connections between components. If they are
correct, change the entire device.
Leak in any of the By pump manipulation or by ultrasound, determine
components. whether there is a leak. If there is a leak, replace all
the components (because body fluid has entered
into the system).
Occlusive Cuff
Too tight or too loose around Remove improperly-sized cuff. Re-size the urethra
the urethra. with the cuff sizer and implant the proper size.
Punctured or damaged. Remove and replace with new cuff.
Pressure Regulating Balloon
6.0 6.5 7.0 7.5 8.0 9.0 10.0
      
      
      
  
  
  
  
  
Punctured during filling.
11.0
Control Pump
Difficulty activating (or
reactivating) the device.
Activate (Reactivate) Cuff: Optional Methods
If the normal activation method does not work, use one of the following optional
methods.
Side Squeeze Method
1. Squeeze sides of control pump adjacent to
deactivation button to allow fluid to fill the pump
bulb (Figure 50).
Note: It may take several minutes for the pump
to refill.
2. When enough fluid has returned to the pump
bulb, give it a quick, forceful squeeze to
reactivate the system.
Cotton Swab Method
1. Feel control pump to locate deactivation button.
2. Take a cotton tip swab and apply pressure
to area directly behind deactivation button
(Figure 51).
Note: This should unseat the poppet and allow
fluid to fill pump and then cuff.
3. When enough fluid has returned to the pump
bulb, give it a quick, forceful squeeze to
reactivate the system.
Fulcrum Method
1. Feel the control pump, locate the deactivation
button, and place your index finger above it (at
tubing side) (Figure 52).
2. Place tip of your thumb below deactivation
button on the opposite side.
3. Place index finger of your other hand on firm
portion of pump (valve block portion) in front of
deactivation button (toward the pump bulb).
4. Firmly bend pump end down to activate, by using
thumbs as a fulcrum.
5. Release after bending.
6. When enough fluid has returned to the pump
bulb, give it a quick, forceful squeeze to
reactivate the system.

REFERENCES

1 Shumaker SA, Wyman JF, Ubersax JS, McClish JA, Fantl JA. Health-related Quality of Life
Measures for Women with Urinary Incontinence: the Incontinence Impact Questionnaire
and the Urogenital Distress Inventory. Quality of Life Research, 3:291-306. 1994.
2 Health Outcomes Institute, Health Status Questionnaire 2.0, 1993 and Rand Health
Services Program, RAND 36-item Health Survey 1.0, 1986.
3 Rosenberg M. Society and the Adolescent Self-Image. Princeton, New Jersey:
Princeton University Press, 1965.
4 Haab F, Trockman BA, Zimmern PE, Leach GE. Continence and Quality of Life after
the Artificial Urinary Sphincter: Minimum 3.5 years follow-up. Journal of Urology 1997;
158:435-439.
5 Litwiller SE, Kim KB, Fone PD, DeVere White RW, Stone AR, Post-Prostatectomy
Incontinence and the Artificial Urinary Sphincter: A Long-term Study of Patient
Satisfaction and Criteria for Success. Journal of Urology 1996; 156:1975-80.
6 Fleshner N, Herschorn S., The Artificial Urinary Sphincter for Post-radical
17
Remove and replace with new pressure regulating
balloon.
Squeeze and release the sides of the control pump
adjacent to the deactivation button to allow fluid to
fill the pump bulb. When enough fluid has returned to
the pump bulb, give it a quick, forceful squeeze.
Figure 50. Side squeeze
method
Figure 51. Cotton swab
method
Figure 52. Fulcrum method
Black (K) ∆E ≤5.0