Artificial Urinary Sphincter (AUS)

The urinary sphincter is a circular muscle enveloping your urethra. It is located around the part of the urethra just after the urethra passes through the prostate. Normally, your sphincter remains closed when you want to hold your urine, and it opens when you want to use the toilet. When the urinary sphincter does not close properly, urine may leak during activity and even at rest. Male patients who have undergone radical prostatectomy, transurethral resection of the prostate (TURP), pelvic trauma, or pelvic radiation are particularly susceptible to this type of leakage. Neurologic disorders can also affect the ability of the sphincter to close tightly.

Fortunately, the Artificial Urinary Sphincter can reduce or eliminate leakage for many male patients with this type of leakage. The AUS works by using a small, water-filled cuff to compress the urethra, holding urine inside the bladder until the patient is ready to urinate. When the patient is ready to urinate, he can simply depresses a button in the scrotal sac causing the small cuff to open, and urine flows out through the urethra. The cuff then re-inflates on its own, assuring that the urethra is compressed and the patient stays dry.

The AUS works through three main components: a cuff (or cuffs), a pump and a balloon. When one needs to urinate, you simply squeeze and release the pump located in the scrotum. This action pulls the fluid out of the cuff and sends it to the reservoir located in the lower abdomen. Because the empty cuff is no longer compressing the urethra, the urine can flow out of the bladder. A few minutes after the bladder is empty, the fluid automatically returns from the reservoir to the cuff around the urethra. Once the cuff is refilled, the urethra is squeezed closed again. The procedure to insert the AUS requires a general or spinal anesthetic and usually takes approximately 90 minutes to complete. Two incisions are typically made. One along the groin or lower abdomen and another in the area between the scrotum and the anus called the perineum. Patients typically stay overnight in the hospital.

What to expect afterwards:

After the surgery healing takes about 4-6 weeks. Swelling and bruising of the perineum and scrotum is expected. Immediately after surgery the cuff is left open and one can expect to continue to leak urine just as before surgery. On follow-up in the office the doctor will activate the cuff and urinary control will begin. After surgery it is important to ice the groin and perineal incisions and keep the scrotum elevated to help decrease the swelling. Heavy lifting should be avoided for 4-6 weeks after surgery. It is also advised not to soak in a tub or pool for 4-6 weeks but showering is fine after the first three days.