Why do I need an artificial urethral sphincter (AUS)?
When you empty your bladder, the urine flows out through a tube called the urethra. The urethral sphincter is the muscle which holds the urine in the bladder until you are ready to go. If the sphincter muscle is damaged (eg by surgery) or if the nerves that make the sphincter work are damaged, then urine may leak out.
It is quite common to become incontinent after undergoing prostate surgery for prostate cancer (radical prostatectomy). Pelvic muscle exercises can often help this to recover, but if it doesn’t settle in the months after surgery then operations to improve incontinence may be suggested.
What is an AUS?
An AUS (Artificial Urinary Sphincter, or Artificial Urethral Sphincter) is a mechanical device which takes the place of the damaged sphincter to help improve incontinence.
The device consists of a cuff, a pump and a pressure-regulating balloon. The cuff is placed around the urethra (water passage) and can fill with fluid, compressing the urethra and preventing urine from getting out.
The pump is the part the patient squeezes to deflate the cuff when the bladder needs emptying. The pump is put under the skin where the patient can easily get at it (eg in the scrotum for men).
The pressure-regulating balloon is placed in the lower abdomen and is filled with fluid. After you deflate the cuff by squeezing the pump, the balloon will automatically refill the cuff after a minute or so, closing off the urethra once more. These three components are connected by plastic tubes, all under the skin.
How successful is the Artificial Urinary Sphincter operation?
There is an 85% success rate (where patients regain control of their bladder) from this type of surgery. 15% of patients will have some degree of ongoing bothersome urinary leakage.
Are there any alternatives to an artificial sphincter?
If you are not keen to have surgery, we can try convenes/sheaths or incontinence pads to manage your symptoms. Sometimes, a Male Sling (eg AdVance sling) device can be used for milder cases of incontinence in men.

What happens during the procedure?
Usually, you will be given a general anaesthetic (ie you will be asleep throughout the procedure). You will be given some antibiotics to reduce the risk of an infection.
You will have a small incision in the area between the scrotum and anus (the perineum) and the cuff will be placed around the waterpipe (urethra). A separate incision will be made in the lower abdomen or groin. Through this second wound, the pump will be placed in the scrotum and the balloon placed in the abdomen.
What happens immediately after the procedure?
You may have a catheter for a day or two after the operation, but that will be removed before you go home. You will usually be discharged home two or three days after your surgery.
The artificial sphincter is kept deactivated after the operation to allow the body recover from surgery before it is used. There will probably be no change in your incontinence until the device is activated (switched on), and you should use pads or a sheath to control the leakage. You will be reviewed in clinic at 4-6 weeks after the operation and the artificial sphincter can be switched on at that point.
Are there any side-effects?
Common (greater than 1 in 10)
 Blood in the urine , and temporary stinging when you urinate after the procedure
 In the long-term, mechanical failure of the device (most devices will last over 10 years)
Occasional (between 1 in 10 and 1 in 50)
 Urine infection
 Wound infection
 Temporary insertion of a bladder catheter
 Later failure of the device as the cuff becomes lose around the waterpipe
(urethral atrophy)
Rare (less than 1 in 50)
 Erosion of the cuff through the waterpipe (urethra)

What should I expect when I get home?
You should take things easy, especially for the first two weeks. Heavy lifting or exertion may cause bruising and swelling and slow you recovery. After two weeks, you can resume most normal activities, but strenuous exertion is not advised.
Cycling, horse-riding and other activities which cause extra pressure on the perineal wound (between the anus and scrotum) should be avoided. Sexual intercourse can be resumed after you have been reviewed in clinic.
You will be advised to massage the scrotum, where you can feel the control pump, to keep the tissue supple. You should do this twice a day.
Antibiotics will be provided for 2 weeks after the operation as a routine precaution. Simple painkillers will also be provided, and laxatives should be used if you are constipated.
It is important to keep your wounds clean and dry. You should wash daily and pat the wounds dry with a clean towel afterwards. We advise you do not take a bath for 2 weeks after your surgery but you may shower 48 hours after surgery.