IMPLANTATION OF AN ARTIFICAL URINARY SPHINCTER
ABOUT IMPLANTATION OF AN AUS
An artificial urinary sphincter (AUS) is a device which is implanted in men to treat severe incontinence of urine.
The AUS has three parts.
- There is a cuff which wraps around the urethra (the pipe you pass urine through). The cuff is inflated with water to stop or reduce leaking of urine.
- There is a pump which is placed in the scrotum. Squeezing the pump causes the cuff to deflate for a few minutes, which allows you to pass urine normally.
- There is a reservoir called a pressure regulating balloon, which is implanted in the abdomen. This reservoir regulates the flow of water in and out of the cuff.
The whole device is completely concealed with no external parts.
WHY IS IMPLANTATION OF AN AUS REQUIRED?
An AUS is implanted to treat severe stress urinary incontinence in men. This type of urinary incontinence may result from surgery for prostate cancer, surgery for benign prostate enlargement, or severe trauma.
WHAT DOES IMPLANTATION OF AN AUS INVOLVE?
The procedure is performed under a general anaesthetic (completely asleep).
We make an incision on the perineum (the skin between the scrotum and the anus). We find the urethra and place the cuff around it.
We make another small incision in the groin. Through this incision we place the pressure regulating balloon in the abdomen, and the pump in the scrotum.
We connect all three parts of the device together with tubes. We fill the whole device with water and test it to make sure it is working. We leave the device deactivated at the end of the procedure to allow your tissues to heal.
We close the incisions with dissolvable stitches.
We place a catheter into the bladder through the urethra to drain urine for the first 24 hours after the procedure.
WHAT IS THE RECOVERY AFTER IMPLANTATION OF AN AUS?
You will usually stay in the hospital for one to two nights after the procedure.
The catheter will be removed on the first day after the procedure. Occasionally it has to be replaced if you are unable to pass urine due to swelling in the urethra.
You will have antibiotics through a drip for 24 hours after the procedure, and tablet antibiotics for one week.
A dressing will be place on the wounds. Your surgeon will tell you when it can be removed. The wounds will need to stay dry for a few days. Do not soak in the bath or go swimming for at least two weeks after the procedure.
You will be given instructions for pain relief to take home from hospital. Regular paracetamol for a few days is recommended. Stronger pain relief can be use on an as needs basis.
Constipation is common after surgery. To avoid constipation, drink plenty of water, eat a diet high in cereals, grains, fruit and vegetables, and go for gentle walks. Over the counter medications for constipation are available from all pharmacies if required.
Swelling and bruising in the scrotum and the perineum is common. It may take several weeks to resolve.
The stitches are disolvable. They do not need to be removed.
You can usually drive after one to two weeks.
You can usually return to work after one to two weeks, but you will need to be on light duties for four to six weeks.
Avoid strenuous activities including heavy lifting and vigorous exercise for four to six weeks.
The device will be activated four to six weeks post-operatively. You will still be incontinent of urine until the device is activated.
WHAT ARE THE RISKS OF IMPLANTATION OF AN AUS?
Common (1/2 – 1/10)
- You may still have minor leaking or dribbling, especially with strenuous activity.
Occasional (1/10 – 1/50)
- Failure to improve urinary incontinence.
- Recurrence of urinary incontinence, requiring further surgery to fix.
- Mechanical failure of the AUS device, requiring further surgery to replace it.
- Infection of the AUS device, requiring further surgery to remove it.
- Erosion of the device through the urethra, requiring further surgery to remove it.
- Bleeding requiring further surgery to fix.
- Infection in the wounds or urinary tract, requiring antibiotics.
- Inability to pass urine when the catheter is removed, requiring the catheter to be replaced, or a catheter placed through the front wall of the abdomen (suprapubic catheter).
- Severe scrotal swelling and pain.
- An injury to the urethra requiring the procedure to be stopped, a catheter placed for several weeks, and the procedure repeated after several months.
Rare (1/50 – 1/250)
- An injury to the bladder, requiring it to be repaired.
- A hernia at the incision on the abdomen.
WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?
Conservative measures including incontinence pads, pull ups, or a condom-like device to catch leaking urine is an alternative to surgery.
Pelvic floor muscle exercises may improve severe urinary incontinence in some men but may not be enough to get you completely dry.
A urethral sling is an alternative operation which is more commonly used for men with mild to moderate urinary incontinence.
A urinary diversion is a major operation to divert the flow of urine away from the bladder and into a segment of bowel, which empties through the abdomen into a bag. It is not necessary very often.
A permanent catheter is an option for men who do not want an operation or are unsuitable for an operation due to other medical problems.
WHERE CAN I FIND MORE INFORMATION ABOUT THIS PROCEDURE?
British Association of Urological Surgeons (BAUS): Artificial urinary sphincter leaflet
Continence foundation of Australia: Continence management following prostate surgery
Prostate cancer foundation of Australia: Understanding urinary problems following prostate cancer treatment