Artificial Urinary Sphincter Implantation in Men

Artificial urinary sphincter implantation in men

Artificial urinary sphincter implantation, or AUS, is a common treatment for moderate to severe stress urinary incontinence. 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, running or lifting.

When should I consider an AUS?

AUS is generally recommended in case of severe urinary incontinence, or if sling implantation has failed to cure or improve your condition. AUS has a long-lasting effect and improves your quality of life.
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.
The doctor will do some tests to make sure that there are no contraindications for getting an AUS. As part of this assessment, you will need a cystoscopy, and a pad test.

 

The procedure

How is the AUS implanted?

For the procedure you usually receive spinal anaesthesia, but in some cases you may be recommended general 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 perineum to place the cuff around the urethra. Then the doctor inserts the reservoir through a second incision in the lower abdomen. Finally, the pump is positioned in the scrotum, and is connected to the other two elements of the device. The cuff is left open until the doctor activates it a few weeks later.

Fig. 1: AUS implantation in the male lower urinary tract.

How to 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. If you need general anaesthesia you must not eat, drink, or smoke for 6 hours before surgery. 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.

 

After the procedure

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. 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 sexual activity
  • Avoid cycling or horseback riding.

After AUS implantation, you will need a specifically designed seat to prevent the pump from accidentally activating during these activities.

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
  • Notice the wounds start to bleed or leak transparent fluid, or hurts
  • Notice swelling, pain, or redness in the scrotum

Advantages

Disadvantages

  • Very low risk of injury to the urethra, rectum, or the bladder during surgery
  • Very low risk of injury to the bowel or blood vessels in the pelvic area
  • Very low risk of temporary urinary retention after surgery
  • Very low risk of urgency urinary incontinence
  • Very low risk of recurrence of stress urinary incontinence
  • Risk of bruising or bleeding in the abdomen
  • Risk of urinary tract infection
  • Risk of infection of the device
  • Risk of erosion of the AUS into the urethra
  • Risk of mechanical failure of the device
  • More invasive than sling implantation
  • Requires the ability to operate the device and to manually control the pump
  • You will remain incontinent until the device is activated 4-6 weeks after surgery