Artificial Urinary Sphincter Implantation in Women
Artificial urinary sphincter implantation, or AUS, is a second-line treatment for moderate to severe stress urinary incontinence (SUI). With the help of a hand-controlled pump, the AUS allows you to control your bladder by compressing and releasing a cuff around the urethra.
The goal of the AUS is to reduce urine leakage during activities such as sneezing, coughing, laughing, or running. The AUS consists of an inflatable cuff which is placed around the urethra, a reservoir to hold urine, and a pump to control the cuff.
When should I consider AUS implantation?
Usually AUS is indicated in complex cases, after a previous surgical treatment to cure or improve SUI has failed. Your doctor may recommend it when other treatment options have a low chance of being successful.
The doctor will ask you to do a urodynamic test to make sure there are no contraindications for getting an AUS.
You have to be able to manually control the pump. Before the surgery is scheduled, the doctor or nurse will sit down with you to discuss how the device works and to make sure you feel comfortable using it.
How is the AUS implanted?
For the procedure you usually receive general anaesthesia, but in some cases you may be recommended spinal anaesthesia. First the doctor inserts a catheter to make sure that your bladder is completely empty during the procedure.
The doctor makes an incision in the lower abdomen, to place the cuff around the urethra. Then the doctor positions the reservoir. Finally the pump is placed in the labia and connected to the other two elements of the device (Fig. 1). The cuff is left open until the doctor activates it a few weeks later.
How do I prepare for the procedure?
Before the surgery the doctor will ask for a urine sample to make sure you do not have a urinary tract infection. If you have an infection, your doctor will prescribe antibiotics before, during, and after the operation.
Your doctor will advise you in detail about how to prepare for the procedure. You must not eat, drink, or smoke for 6 hours before surgery to prepare for the anaesthesia. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Your doctor will advise you on when you can start taking it again.
How long will it take me to get back to my daily activities?
The doctor will generally remove the catheter the day after the surgery and monitor your recovery. You may have to take antibiotics to prevent an infection. If you are able to urinate without any problems and there is not much residual urine in the bladder, you will be discharged from the hospital a few days later. The length of hospital stay can vary in different countries.
After you leave the hospital, your body still needs time to fully recover from surgery. Because of this, the AUS will not be activated until your lower urinary tract has completely healed. This means that in the weeks after the procedure you will continue to have urine leakage. During this time you may also experience pain in the pelvic area, or feel pain when you urinate. Your doctor can prescribe medication to deal with these symptoms.
The doctor will schedule an appointment to activate the device 4-6 weeks after surgery.
During the recovery period your doctor may recommend to:
- Drink 1-2 litres every day, especially water
- Not lift anything heavier than 5 kilograms
- Not do any heavy exercise
- Take showers instead of baths
- Avoid thermal baths, or going to the sauna
- Prevent constipation by adapting your diet
- Avoid vaginal penetration
You need to go to your doctor or go back to the hospital right away if you:
- Develop a fever
- Are unable to urinate on your own
- Have heavy blood loss or pain
- Have blood in the urine
- Notice the wounds start to bleed or leak transparent fluid, or hurt