Artificial sphincter (AUS) - urinary; Inflatable artificial sphincter
Sphincters in the urinary system are muscles that allow your body to hold in urine. An inflatable artificial (man-made) sphincter is a medical device. This device keeps urine from leaking. It is used when your urinary sphincter no longer works well. When you need to urinate, the cuff of the artificial sphincter can be relaxed. This allows urine to flow out.
Other procedures to treat urine leakage and incontinence include:
This procedure may be done while you are under:
An artificial sphincter has 3 parts:
A surgical cut will be made in one of these areas so that the cuff can be put in place:
The pump can be placed in a man's scrotum. It can also be placed underneath the skin in a woman's lower belly or leg.
Once the artificial sphincter is in place, you will use the pump to empty (deflate) the cuff. Squeezing the pump moves fluid from the cuff to the balloon. When the cuff is empty, your urethra opens so that you can urinate. The cuff will re-inflate on its own in 90 seconds.
Artificial urinary sphincter surgery is done to treat stress incontinence. Stress incontinence is a leakage of urine, which occurs with activities such as walking, lifting, exercising, or even coughing or sneezing.
The procedure is recommended for men who have urine leakage with activity. This type of leakage can occur after prostate surgery. The artificial sphincter is advised when other treatments do not work.
Women who have urine leakage most often try other treatment options before having an artificial sphincter placed. It is rarely used to treat stress urinary incontinence in women in the United States.
Most of the time, your health care provider will recommend medicines and bladder retraining before surgery.
This procedure is most often safe. Ask your provider about the possible complications.
Risks related to anesthesia and surgery in general are:
Risks for this surgery may include:
Always tell your provider what medicines you are taking. Also let the provider know about the over-the-counter medicines, herbs and supplements that you bought without a prescription.
During the days before the surgery:
On the day of your surgery:
Your provider will test your urine. This will make sure you do not have a urinary infection before starting your surgery.
You may return from surgery with a urinary catheter in place. This catheter will drain urine from your bladder for a little while. It will be removed before you leave the hospital.
You will not use the artificial sphincter for a while after surgery. This means you will still have urine leakage. Your body tissues need this time to heal.
About 6 weeks after surgery, you will be taught how to use your pump to inflate your artificial sphincter.
You will need to carry a wallet card or wear medical identification. This tells providers you have an artificial sphincter. The sphincter must be turned off if you need to have a urinary catheter placed.
Women may need to change how they do some activities (such as bicycle riding), since the pump is placed in the labia.
Urinary leakage decreases for many people who have this procedure. However, there may still be some leakage. Over time, some or all of the leakage may come back.
There may be a slow wearing away of the urethra tissue under the cuff. This tissue may become spongy. This may make the device less effective or cause it to erode into the urethra. If your incontinence comes back, changes may be made to the device to correct it. If the device erodes into the urethra, it will need to be removed.
American Urological Association website. What is stress urinary incontinence (SUI)? https://www.urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui). Accessed August 23, 2022.
Danforth TL, Ginsberg DA. Artificial urinary sphincter. In: Smith JA Jr, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 102.
Thomas JC, Clayton DB, Adams MC. Lower urinary tract reconstruction in children. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 37.
Wessells H, Vanni AJ. Surgical procedures for sphincteric incontinence in the male. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 131.BACK TO TOP
Review Date: 4/10/2022
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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