[Caroline]

I was born with only one kidney and also without the neck og my bladder leading to all kinds of problems when I was younger. When I was 6 years old I had surgery and they put in an artificial sphincter muscle since I was completely incontinent. After the surgery I gradually got better and better and become completely continent. However, they never activated the pump on the sphincter muscle for some reason but I have never needed it to be activated so it hasn't posed an issue. Anyways, I delt with lots of problems concerning bladder and kidney infections after my surgery but those days are over for the most part. I switched from a conventional doctor to a naturopath after my mother found out that my other urologists wanted me to stay on strong medications for the rest of my life. Anyways, I have since of course visited my urologist and nephrologist to make sure that everything was running smoothly which it has. Last year I got married and moved from the US to Egpyt. I haven't found a urologist or a nephrologist that I can talk to here and regular MD's haven't been much help. So....I thought maybe someone could answer my questions here.

How will pregnancy affect my artificial sphincter muscle? I am not pregnant right now and I am not planning on becoming pregnant anytime soon but would like to know what would happen should I become pregnant. I have two very large scars on my abdomen which still hurt if you press down on them. My doctors told me it was probably because of the buildup of scar tissue.
Also, I have been told that since the pump was not activated that it could possibly be removed?
One last question, should I ever need to replace the sphincter muscle? My artificial sphincter muscle is made out of non metallic stainless steel (yes...I know that sounds like an oxymoron but I had to have an MRI done for a different problem and so I found out what it was made out of). I am not sure exactly how it works since the pump is not activated but any help that you could give me would be much appreciated! Thanks!

[UroDoc]

An artificial sphincter is not a muscle but a silicone cuff that is placed around the urethra or bladder neck (yours is probable bladder neck). When activated it fills with fluid and compress the urethra. In some patients like yourself the non activated cuff provides enough support that it stops the leakage of urine. One concern is that the sphincter will erode through the tissue of the bladder neck or urethra and need to be removed and replaced. This is less likely to happen on a non activated cuff. I have never had a patient become pregnant with a sphincter in place but I would worry that a vaginal birth may cause damage to the sphincter bladder neck area leading to erosion of the sphincter. A C section maybe a better option as long as the OB knows where the mechanisms are. Besides the pump you have a reservoir in your abdomen, in the bladder area, which is filled with fluid which would fill the cuff if the sphincter was activated.The other thing that you need to be careful of his the use of foley catheters to drain your urine since if forcefully placed they can erode your sphincter, although this is more likely if the sphincter was activated. The only metal parts on your artificial sphincter is the valve in the pump and that is very small. I would ask the doctors that put it in how they feel about pregnancy and a vaginal versus C section delivery, good luck.