What is an Artificial Urinary Sphincter?
An artificial urinary sphincter or AUS is a mechanical device that can restore control of urine to men who have stress urinary incontinence. Stress urinary incontinence is the loss of urine when the pressure inside the bladder increases, such as during coughing, sneezing, or lifting a heavy object. It most commonly occurs in men after a surgery on the prostate, such as a radical prostatectomy or transurethral resection of the prostate.
The artificial urinary sphincter consists of 3 parts:
- Cuff: Controls urine flow through the urethra
- Balloon: Regulates pressure in the cuff
- Pump: Inflates the cuff
Who is a Candidate for an Artificial Urinary Sphincter?
Men with significant stress urinary incontinence after prostate surgery, or men with any amount of stress urinary incontinence after radiation to the prostate can consider placement of an artificial urinary sphincter. Your surgeon can discuss the risks and benefits of this procedure with you.
Procedure of Open Artificial Sphincter Implant
The implantation of the artificial sphincter is carried out under general or spinal anesthesia. Your surgeon makes incisions in the perineum and groin to insert the artificial sphincter. First, the cuff is inserted through the perineal cut and placed around the urethra. The balloon is then positioned below the abdominal tissue and the pump is placed in the scrotum.
If the urethra is damaged the surgery cannot be safely completed. This happens less than 1% of the time. If this occurs, the surgery must be delayed by 2-3 months to allow healing.
Risks of Open Artificial Sphincter Implant
Implantation of the sphincter is generally safe, but like all surgeries, the procedure may be associated with certain side effects, such as damage to the bladder and urethra, difficulties in emptying the bladder, and infection.
These devices are mechanical and can wear out. They can last for many years, but 50% fail by 10 years.
There are alternate minimally invasive/laparoscopic procedures that can be availed of. The open artificial sphincter implant is restricted to selected cases only. Your surgeon will discuss your options with you based on your particular medical history.
How Do I Use an Artificial Urinary Sphincter
The inflated cuff squeezes the urethra closed and prevents the leakage of urine from the bladder. When you feel the urge to urinate, you can deflate the cuff by squeezing the pump. This transfers fluid from the cuff into the balloon and releases the pressure around the urethra. The cuff re-inflates on its own in 90 seconds.