Artificial Urinary Sphincter (AUS)

For Urinary Incontinence

Urinary incontinence (UI) can be a disruptive and debilitating condition that keeps patients in their homes or near a bathroom when they otherwise might be enjoying many of the activities they once did. While there are solutions in the form of pads or adult briefs that can minimize the public-facing embarrassment associated with urinary incontinence, these can become cumbersome and expensive and ultimately do not treat the underlying concern.

Fortunately, modern medical device technology has given rise to several options, including the artificial urinary sphincter or AUS for men with severe incontinence.

The AUS comprises an inflatable cuff that wraps around the urethra, connected to soft, flexible, biocompatible tubing, a control pump that sits in the scrotum, and a saline-filled balloon placed in the pelvic area. The cuff defaults closed, not letting urine pass through the urethra. However, with a few pumps of the scrotal control pump, the pressure releases allowing the patient to void, and it automatically re-closes on its own.

How the AUS Is Implanted

The AUS is traditionally implanted using two incisions – the perineum – the area between the scrotum and the anus and a second above the pubic bone. The procedure is performed under general anesthesia with a long-acting anesthetic to allow for a more comfortable recovery. The method requires approximately one to two hours of surgical time and is typically performed in a hospital setting. Most patients are discharged home the same day with few significant limitations other than wound care and ensuring the device is used appropriately.

The AUS has a very high satisfaction rate and effectively minimizes leakage. Most patients will enjoy between 8-10 years of leak-free, predictable urination, at which point the device may need to be replaced.

Possible Reasons Why the Patient Might Need an AUS

While stress urinary incontinence can occur for several reasons, the most common application of the AUS is post-prostatectomy or removal of the prostate. Every man has two urinary sphincters—one within and one outside of the prostate. When the prostate is removed, the remaining urinary sphincter must make up for the absence of the other. Depending on how robust this valve is, this may cause long-term urinary leakage. Fortunately, approximately 95% of men regain their continence after a radical prostatectomy. For the remaining 5% that are not restored to their pre-surgical continence, a male sling for milder incontinence or an artificial urinary sphincter for severe cases may be a good option.

Risks and Considerations of the AUS

Implanting an AUS is a surgical procedure, and as such, there are some inherent risks that every patient should be aware of.

The first and most crucial risk factor is infection. Infection rates have steadily declined as the AUS device has been improved with an antibiotic coating. That said, there’s still a small chance, approximately one to two percent, of an infection developing.
Though the device is durable, there is a very small possibility of device failure, which would necessitate removal and reimplantation.
Pain and some blood loss are to be expected, as they would be for any surgical procedure. As mentioned above, long-acting anesthesia is used to minimize the pain, and bleeding should improve over a few days.
Because of gravity’s effects, blood may pool in the scrotum and cause swelling. This is normal and will be described in your postoperative instructions.
The urinary cuff may erode into the urethra, requiring another procedure.
Incontinence can recur after many years of use.

The Bottom Line

The artificial urinary sphincter (AUS) is the gold standard for urinary incontinence that can be caused by any number of concerns including urinary incontinence issues resulting from a radical prostatectomy, benign enlarged prostate surgery or radiation for prostate cancer surgery. The AUS offers predictable urination with a discreet solution housed entirely within the body. With improvements in medical device technology, these artificial sphincters have lasted longer than ever before, and most men are thrilled with the outcome.

Alongside our comprehensive post-prostatectomy continence and erectile function rehabilitation program, the artificial urinary sphincter means that virtually every man can enjoy restored continence, no matter the severity of his symptoms.