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IMPLANTATION OF AN ARTIFICAL URINARY SPHINCTER

Image of an artificial urinary sphincter. The artificial sphincter wraps around and closes off the urethra. It is activated by a pump in the scrotum.An artificial urinary sphincter (AUS) is a device which is implanted in men to treat severe urinary incontinence. It is often used for the management of incontinence after prostate surgery.

At Brisbane Urology Clinic, several of our urologists have a special interest and expertise in male urinary incontinence and AUS implantation. 

 

HOW DOES AN AUS WORK?

The AUS has three parts:

  • A cuff filled with fluid which wraps around and closes off the urethra (the pipe you pass urine through). 
  • A pump in the scrotum which is used to deflate the cuff.
  • A fluid reservoir in the abdomen which regulates the flow of fluid in and out of the cuff.

The whole device is completely concealed with no external parts.

In the resting state, the urethral cuff is inflated with fluid, which closes off the urethra.

Squeezing the pump in the scrotum causes the cuff to temporarily deflate, which allows you to pass urine. Over a few minutes the cuff gradually re-inflates to close off the urethra again. 

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
  • 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 fluid reservoir in the abdomen and the pump in the scrotum.

We connect all three parts of the device together. 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.

The device will be activated four to six weeks post-operatively. You will still be incontinent of urine until the device is activated.

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.

Minor swelling and bruising in the scrotum and the perineum is common. It may take several weeks to resolve.

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.

The risks of anaesthesia have not been listed here. 

WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?

Alternative treatment options for the management of stress urinary incontinence in men include:

  • Conservative measures such as incontinence pads, pull ups, or a condom-like device to catch leaking urine.
  • 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 stress 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.
REFERENCES
  • Smith, J. A., Howards, S. S., Preminger, G. M., & Hinman, F. (2012). Hinman’s Atlas of urologic surgery. Philadelphia: Elsevier/Saunders.
  • Image and video: Boston Scientific

This is general information only. Please consult your doctor for more information and treatment options.