Implanting an artificial urinary sphincter, or AUS, is a treatment of last resort for SUI. It is sometimes used when the muscles that control urine storage are badly impaired, resulting in a complete inability to hold urine.
The AUS allows you to control your bladder with a hand-operated pump to compress and release a cuff around the urethra. The AUS consists of:
- An inflatable cuff placed around the urethra
- A reservoir to store liquid and keep the pressure in the system
- A valve or pump to control the cuff
The goal of the AUS is to reduce urine leaks during physical activities such as sneezing, coughing, laughing, or running. In women, the AUS has high risks of complications, mechanical failure, and need for removal.
When should I consider AUS implantation?
An AUS should be considered only for patients with complex problems, especially if previous surgical treatment for SUI didn’t work. Your doctor may recommend an AUS when other treatment options have a low chance of success.
The doctor will ask you to do a urodynamic test to make sure your urine flows normally. This test will confirm that you can use an AUS.
To use an AUS, you must be able to manually control the valve. Before surgery is scheduled, the doctor will meet with you to discuss how the device works and to make sure you feel comfortable using it.
How is the AUS implanted?
You will typically be unconscious (general anaesthesia) for this procedure. Spinal anaesthesia can also be used to block nerve response to pain.
- The bladder is emptied. The surgeon will insert a catheter to make sure that your bladder is completely empty during surgery.
- Incisions are made. The surgeon makes a cut in the lower abdomen to place the reservoir.
- The AUS is placed. A small cut is made in the front wall of the vagina and the cuff is placed around the urethra. Finally, the pump is placed in the labia and connected to the other two elements of the device.
The cuff is left open until the doctor activates it a few weeks later in the outpatient clinic.