Artificial Urinary Sphincter
Figure 1: An artificial urinary sphincter.
What are the indications for implantation of an artificial urinary sphincter?
An artificial urinary sphincter (AUS) is an effective treatment for men with bothersome significant stress urinary incontinence (involuntary leakage). In the vast majority of men, this is done for post-prostatectomy urinary leakage.
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests at your consultation prior to your procedure. You will also have a cystoscopy to rule out any blockages and you may need urodynamic studies if there is any doubt about the diagnosis.
It is important that any urine and skin infections around the genital areas are completely treated. If you have diabetes, your urologist will liase with your GP / specialist to ensure it is well controlled to reduce risk of infection after the operation. You MUST stop smoking before your prosthesis surgery.
You will be given an antibiotic wash, which you should use to clean your abdomen and genital area for 3 days before the operation. You should not shave or clip any hair in your genital area – this will be done by the urologist at the time of surgery.
If you take any blood thinning medication such as aspirin, warfarin, plavix (clopidogrel) and anticoagulants, you should discuss this with your urologist, as they may need to be stopped temporarily.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be admitted the evening prior to your procedure and given intravenous antibiotics early in the morning of surgery. You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications with you to the hospital. After you are admitted, your urologist will see you in the morning to discuss the surgery. An anaesthetist will see you to discuss the general anaesthetic before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does the procedure involve?
The AUS is a device that is placed in a concealed position around your urethra (waterpipe) to help control urinary leakage in men with moderate to severe stress urinary incontinence. The control pump that activates the cuff around the water pipe sits in the scrotum and a pressure- regulating balloon is placed in your abdomen (pictured right).
The cuff squeezes the waterpipe to limit urine leakage; it is then activated to deflate the cuff and allow you to pass urine. The cuff will then re-inflate automatically to stop any further urine flow.
After a general anaesthetic, you are given some intravenous antibiotics to reduce the chance of infection. The genital area is shaved and cleaned with antiseptic for five to 10 minutes to minimise the risk of infection. A small cut is made in the skin between your scrotum and back passage to place the cuff around the waterpipe. A second incision is made in your abdomen to position the reservoir near the bladder. The control pump is placed in your scrotum between your testicles.
The devices are filled with fluid, air is expelled from the cylinders & connecting tubing, and inflation is tested whilst you are asleep. The incisions closed with dissolving stitches. You will likely have a small drain left in the wound and you will have a catheter to drain urine from your bladder overnight. A waterproof dressing is used to cover the wounds.
You will stay in hospital overnight for more intravenous antibiotics the next morning. Your drain and catheter will be removed the next morning and you will be discharged with the dressing intact and on oral antibiotics for 1 week.
Are there any risks or side‑effects of insertion of an artificial urinary sphincter?
Figure 2: Positioning of the implanted artificial urinary sphincter.
Swelling and bruising of the area lasting a few days 80-100%
Minor ooze of the wound 10-20%
Minor infection of the incision requiring antibiotics 5-10%
Infection / bleeding needing removal of prosthesis after first time implantation 2-5%
Infection needing removal of prosthesis after subsequent implantations or complex surgery 5-10%
Malfunction of the prosthesis 5-10% over 5-10 years
Erosion of the device needing further surgery 5-10%
New onset of urgency and urge-related leakage 5-10%
Urethral shrinkage needing revision surgery 5-10%
Persistence tenderness / discomfort at the surgical site 3-5%
Injury to bladder, urethra or other organs during implantation 1-2%
Major cardiovascular or anaesthetic problems - rare
What should I expect on discharge when I get home?
You will experience some swelling, discomfort and sensitivity at the operative site for a couple of weeks, which should settle with time and with paracetamol and/or ibuprofen. Take your antibiotics as prescribed for a week. Keep the waterproof dressing on for 7 days. The skin sutures are self-dissolving (takes 2-4 weeks) and do not need to be removed.
After 5-7 days, you can begin light activities and duties again. You should only return to strenuous activity, heavy lifting and driving when you are completely pain free and when your GP is happy with your progress (at least 4 weeks). You should refrain from sexual activity for a minimum of six weeks.
Until the device is activated at 6 weeks, you will be incontinent. After activation, most men are dry with only minor leaks or dribbles of urine during strenuous exercise or exertion you will have minor leaks. This can be managed by wearing a safety pad when you expect to engage in such activities.
If you develop swelling, fevers or significant pain and redness at the site, you should contact your GP.
What follow-up will I need?
Your urologist will see you in the clinic in 1-2 weeks for a wound check and at 6 weeks to activate the AUS.
If you have abdominal, groin, perineal or cystoscopic surgery at any future time, you MUST tell any surgeon that you have an AUS. Failure to do so may put parts of the AUS at risk of damage during any later surgery.