Urologists at Urology Associates implant artificial urinary sphincters to treat male urinary incontinence in properly selected patients. The artificial urinary sphincter (AUS) is a device placed completely inside your body to provide urinary control and may be used to treat severe urinary incontinence. You control urination by squeezing and releasing a pump located in the scrotum.
When using this device, most men are dry with only minor leaks or dribbles of urine, usually with strenuous exercise or exertion. As with any medical procedure, the AUS is not 100% effective in all patients. Some men may require additional protection.

Benefits of the AUS

• Time-Tested—For almost 35 years, the AUS has been used for treating incontinence due to intrinsic sphincter deficiency (ISD) following prostate surgery.
  
• Effective—It is capable of offering most men with severe urinary incontinence the opportunity to achieve continence over time.

How it works

The artificial urinary sphincter mimics a healthy sphincter in that it keeps the urethra closed until you want to urinate. It does this by automatically moving fluid through three main components: a cuff, a pump and a balloon. These components are connected by flexible, kink-resistant tubing.

When you need to urinate, you release the pressure on the urethra so that urine can flow. You do this by simply squeezing and releasing a pump located in your scrotum. This action pulls the fluid out of the cuff and sends it to the balloon. Because the empty cuff is no longer pressing the urethra closed, urine can flow out of the bladder.

Minutes after the bladder is empty, the fluid automatically returns from the balloon to the cuff. Once the cuff is refilled, the urethra is again squeezed closed.

Procedure

The AUS is placed during a surgical procedure under general anesthesia, usually lasting about 45 to 90 minutes. One or two small incisions are made near the scrotum and in the abdomen to implant the cuff, balloon and control pump.

In general, placing an AUS involves the following steps. (Your doctor's method may vary slightly from this one.)

1. The doctor makes an incision near the scrotum, performs dissection to the urethra, measures the urethra to determine the right size cuff, and positions the cuff around the urethra.
   
2. The balloon is then placed in the abdomen, and the pump is placed in the scrotum.
   
3. The tubing is connected between the components and they are filled with a sterile fluid, such as saline solution.
   
4. The doctor closes the incision.

What to Expect After the Procedure

After the surgery, your doctor may insert a catheter into the urethra before the incision is closed. The length of time the catheter is left in place is up to the discretion of your doctor. You will require urinary protection until the device is activated six weeks following surgery. This time allows your incision to heal. You may feel some pain in your scrotum immediately after the surgery and when your AUS is first activated. Some pain after surgery is normal and can usually be treated with oral pain medications. If the pain is severe or lasts longer than expected, it may be a sign of a complication that requires medical attention. You should contact your doctor if the pain persists. If you notice any redness, swelling or heat around the incision area, or fluids coming from the incision after the procedure, contact your doctor immediately.

Keep in mind that you have a surgical implant and choose your activities wisely. Trauma to the device may include a seat belt jolt from a car accident, a tackle in a contact sport, or a slip and fall. Trauma may damage the AUS.
MedicAlert Information

It is extremely important to let all healthcare professionals know that you have an AUS so proper precautions can be taken in treating you. This is especially important if a healthcare provider needs to insert a catheter or any other instrument into your urethra; the AUS urethral cuff must be open and the pump must be deactivated before the patient is catheterized or there is a serious risk of injury to the urethra.

Since the AUS is placed entirely inside the body, no one will know you are implanted with the device. This can be a problem if you are involved in a medical emergency such as a traffic accident. For this reason, AMS (American Medical Systems – the manufacturer of the device) recommends that all patients carry an AUS medical identification card and wear a medical alert emblem to let healthcare providers know that you have an AMS Sphincter 800 implanted.

You will receive a permanent plastic medical identification card by mail from AMS. This card provides information about your AUS. Carry your ID card with you at all times.

The AUS is a treatment option for men with moderate to severe stress urinary incontinence due to intrinsic sphincter deficiency (ISD) following prostate surgery. Some manual dexterity and strength are required to operate the pump, which controls the device.

The procedure is not for people with:

• Physical or mental conditions that make them poor candidates for surgical procedures and/or anesthesia
  
• An irreversible blocked or obstructed lower urinary tract
  
• Irresolvable detrusor hyperreflexia or bladder instability (spasms)
  
• Poor manual dexterity