The First Teleautomatic Low‐Voltage Prosthesis With Multiple Therapeutic Applications: A New Version of the German Artificial Sphincter System

Abstract

To date, there are no artificial sphincter prostheses for urinary or fecal incontinence that may be implemented elsewhere instead, for example, in the upper gastrointestinal tract. Conventional systems are conceptually similar but are constructed specifically for distinct applications and are manual in operation. The German Artificial Sphincter System (GASS) II is the evolution of a highly integrative, modular, telemetric sphincter prosthesis with more than one application. Redesigning and integrating multilayer actuators into the pump allows us to reduce the input voltage to -10 to +20 V (V(PP) = 30 V). This provides for a flow rate of 2.23 mL/min and a counterpressure stability of 260 mbar. Furthermore, multiple applications have become feasible due to our standardized connection system, therapy-specific compression units, and application-specific software. These innovations allow us to integrate not only severe fecal and urinary incontinence, erectile dysfunction, and therapy-resistant reflux disease, but also morbid adiposity into the gamut of therapeutic GASS applications.

Montreal electronic artificial urinary sphincters: Our futuristic alternatives to the AMS800™

“…Finally, the possibility of adjusting cuff pressure postoperatively and in real-time would allow slight pressure increments in partially improved patients, as well as cuff deflation during the bedtime period to decrease pressure exerted on the urethra and reducing, in theory, the risk of erosion and atrophy. 19 With volume going from 30 to 50 cm 3 , they are currently the smallest devices to incorporate an electronic pumping system [10][11][12][13] with remote control 13 (Table 1), making them easy to insert through the reservoir implantation incision and easily placed at the iliac fossa in a subcutaneous pouch. As pumping systems are currently handmade, device miniaturization is limited, especially because of Y and L suture-tie connectors at the hydraulic unit level.…”

“…5,6 Influenced by this rationale, few authors have developed novel AUSs to improve the AMS800. 5,[7][8][9][10][11][12][13] Here, we present three distinct AMS800 retro-compatible pumping systems: the AUS#1, AUS#2, and AUS#3, developed recently as a collaborative work between McGill University and École polytechnique de Montréal. Our approach was to improve the AMS800 by incorporating a remotely controlled electronic pump without modifying the cuff and pressure-regulating balloon (PRB).…”

Challenges faced in the clinical application of artificial anal sphincters

“…The redesign comprises the aggregation of all electric and mechanical components into one central unit (Fig. 2b) (Ruthmann et al, 2010).…”

Design and assessment of novel artificial anal sphincter with adaptive transcutaneous energy transfer system

“…Prostheses with different structures similar to an inflatable circular cuff or an elliptical ring fitted around the anorectal bowel have been developed and studied in both animal experiments and clinical trials. These sphincter prostheses have improved incontinence, but to date they have been associated with many complications and have not gained acceptance [2][3][4][5][6].…”