The Artificial Urinary Sphincter (AUS)

The Artificial Urinary Sphincter (AUS) is an established and effective treatment for men with severe stress incontinence.

Specialists at Harley Street Urology have extensive experience of implanting the AUS. These are mechanical devices, which replace the function of a deficient biological sphincter. There is also a new treatment called a male sling which provides an alternative, less invasive option for stress incontinence. Harley Street Urology is leading the world’s first comparative study of male incontinence treatments.

Is this the right treatment for me?

An AUS is only considered for people with the most severe form of stress incontinence. In these conditions, the sphincter control mechanism around the urethra is insufficient to hold back the urine even with minimal activity, such as changing from a sitting to a standing position. In some cases the leakage is so severe that patients are constantly wet at rest and in bed.

The most common causes of this degree of leakage are radical prostatectomy or radiotherapy for prostate cancer, and a TURP procedure for an enlarged prostate. For a small proportion of men who have these procedures, the sphincter control mechanism is damaged during surgery. People who have had congenital abnormalities, spinal cord injury or urethral reconstruction following pelvic fractures may also have intrinsic dysfunction of the sphincter, resulting in severe stress incontinence.

If you have significant incontinence six months to one year after prostatectomy, an AUS implant or a male sling may be considered. The choice of device depends on the degree of incontinence. Male slings are useful for mild to moderate degrees of incontinence, whilst the AUS is very effective for severe incontinence. Your specialist will organise urodynamic investigation and will be able to advise you based on the results of these tests.

What is the artificial urinary sphincter made of?

The AUS is made from a special type of silicone designed to ensure the body won’t react to or reject the material. It has three main parts: a cuff, a pump and a balloon, which are all connected by silicone tubing. The male sling for stress incontinence is made from polypropylene mesh similar to that used in Tension-free Vaginal Tape (TVT).

How is the artificial urinary sphincter fitted?

The artificial urinary sphincter is implanted during an operation, which takes place under general anaesthetic.

The AUS cuff is inserted through an incision made in the perineum – the space between the scotum and anus. A small incision in the groin, similar to that used for a hernia operation, is used to place the balloon in the abdomen and the pump in the scrotum, or the labia in females.

How does the artificial urinary sphincter work?

The AUS cuff is filled with fluid and compresses the urethra keeping it shut. When it is time to urinate, the scrotal pump is used. This has a soft curved end, which can easily and gently be pressed to move the water from the cuff to the balloon, opening the urethra. After a few minutes, the fluid returns from the balloon to the cuff, and the urethra once again becomes tightly closed. For the first six weeks after surgery, the AUS is switched “off”, allowing all swelling to settle. Six weeks after implantation, our doctors or nurse specialist will switch “on” the AUS and explain how to use it.

Advanced urology nurse specialist Julie Jenks

“Male incontinence is a very distressing and socially embarrassing condition. The placement of an artificial sphincter has transformed many of our patient’s lives and restored their social confidence.”

Julie Jenks, Advanced Nurse Practitioner and Medical Acupuncturist, Harley Street Urology

How effective is the artificial urinary sphincter and male sling?

The first AUS was fitted in 1972, although the devices used today are much improved with higher success rates. To date, more than 94,000 men worldwide have been treated with the latest implant, called an AMS 800. Studies show 73 to 96 per cent of patients achieve complete continence after an AUS is implanted.

Are there any complications and problems with the artificial urinary sphincter?

All surgery involves a risk of complications and problems. Studies report a complication/problem rate of 12 per cent after having an AUS fitted. Sometimes the cuff does not provide sufficient pressure on the urethra to stop urine from leaking out of the bladder and the cuff needs to be replaced with one that gives a higher pressure range. Infection and erosion of the cuff can occur, in which case the AUS will have to be removed, and a six-month interval left before reimplantation of a new device. As with other mechanical devices, the AUS has a life expectancy. The average life expectancy of the current device, the AMS 800, is 13 years.