Introduction
Millions of people worldwide struggle with urine leakage. This problem can deeply affect their daily life. When basic treatments don’t work, an artificial urinary sphincter (AUS) can help. This device offers hope to those with severe urine leakage, especially after prostate surgery or due to nerve problems.
In this guide, we’ll explore what an AUS is, how it works, who can use it, and what to expect. Whether you’re thinking about getting one, caring for someone who might need one, or just curious, you’ll find useful info here.
What is an Artificial Urinary Sphincter?
An artificial urinary sphincter is a device surgeons place in your body. It helps control urine flow when your natural muscles can’t do the job. The device keeps your urethra closed until you’re ready to pee.
Basic Parts
The standard AUS has three main parts:
- Inflatable cuff: A fluid-filled ring that wraps around your urethra
- Pressure balloon: A small balloon that holds fluid when the cuff is empty
- Control pump: A small device placed in the scrotum (men) or labia (women) that you can feel and press
How It Works
The AUS works on a simple water-pressure system:
- The cuff stays filled with fluid, gently squeezing your urethra shut
- When you want to pee, you squeeze the pump
- This moves fluid from the cuff to the balloon
- Your urethra opens, letting urine flow
- After 3-5 minutes, the fluid flows back to the cuff, closing your urethra again
History and Development
Doctors have been working on artificial sphincters since the early 1970s.
- 1972: Dr. F. Brantley Scott created the first AUS
- 1983: The FDA approved the AMS 800™ device
- 1987-2000: Better materials made the devices safer
- 2000s-Present: Modern devices last longer and cause fewer problems
Today’s devices work better and cause fewer issues than the early models.
Who Can Benefit?
The artificial urinary sphincter helps several groups of people:
Men After Prostate Surgery
About 1-5% of men who have prostate cancer surgery develop bad urine leakage. An AUS can help them regain control.
People with Nerve Problems
Those with certain health issues may benefit, including people with:
- Spinal cord injuries
- Multiple sclerosis
- Spina bifida
- Cerebral palsy
Women with Stress Incontinence
Some women with severe urine leakage that other treatments haven’t fixed might be good candidates.
Children with Birth Defects
Kids born with certain bladder or urethra problems may need special child-sized AUS devices.
Getting Evaluated
Before suggesting an AUS, doctors will run several tests:
Medical Tests
- Bladder function tests: Check how your bladder works
- Cystoscopy: Look inside your bladder with a tiny camera
- Pad test: Measure how much urine you leak
- Bladder diary: Track when you pee and leak
Personal Factors
Doctors also look at:
- Hand skills: Can you work the pump?
- Mental clarity: Do you understand how to use it?
- Past treatments: Have you tried other options?
- Overall health: Are you healthy enough for surgery?
- Your goals: Do you understand what to expect?
The Surgery
Getting an AUS requires surgery under full or spinal anesthesia.
Before Surgery
- You’ll take antibiotics to prevent infection
- Your doctor will check for bladder infections
- You might need bowel prep
- You’ll stop taking blood thinners temporarily
During Surgery
The 1-2 hour procedure involves:
- Making cuts in your lower belly and, for men, the scrotum (or for women, the labia)
- Placing the cuff around your urethra
- Creating space for the balloon in your belly
- Putting the pump in your scrotum or labia
- Connecting all parts with small tubes
- Filling the system with sterile fluid
- Testing that it works before closing the cuts
Recovery Time
The device stays turned off for 4-6 weeks while you heal. During this time:
- You might have a tube to drain urine
- You’ll take pain medicine
- You’ll limit your activity
- You’ll see your doctor for check-ups
Results and Success Rates
Research shows most properly chosen patients do well with an AUS.
Success Numbers
- Urine control: 75-90% of people see big improvements
- Fully dry: About 50-75% stop leaking completely
- Happy patients: 80-90% say they’re glad they got an AUS
- Better life quality: People report feeling better physically, socially, and emotionally
Dr. Sarah Johnson, a urologist, says: “The artificial urinary sphincter is still our best option for men with severe urine leakage. When we pick the right patients and use good surgery skills, it can truly change lives.”
Possible Risks
While mostly safe, AUS surgery has some risks:
Early Problems (0-3 months)
- Infection: Happens in 1-3% of cases, may need device removal
- Can’t pee: Some have trouble emptying their bladder at first
- Pain: Usually goes away with time
- Blood collection: Can form at surgery sites
Later Problems
- Device breaks: Happens in 5-15% after 5 years
- Cuff damage to urethra: Occurs in 3-5% of patients
- Tissue thinning: The area under the cuff may get thinner over time
- Late infection: Can happen years after surgery
Need for More Surgery
Studies show more surgery is needed in:
- 10-25% of patients after 5 years
- 25-50% after 10 years
Most often, doctors replace parts rather than remove the whole device.
Living with an AUS
People with an AUS must learn new bathroom habits.
Daily Use
- Press the pump before you need to pee
- Wait 3-5 minutes after peeing for the cuff to refill
- Watch for signs of problems
- Follow activity rules, especially early on
Long-term Care
- Go to regular check-ups
- Your doctor might need to adjust the pressure
- Tell other doctors about your implant
- Know you might need a new device after 7-10 years
A Patient’s Story
James, age 67, shares: “After my prostate surgery, I leaked so much I couldn’t leave home. The artificial sphincter gave me my life back. It took time to get used to, but now using it feels normal. I just wish I’d gotten it sooner.”
New Advances
The field keeps growing with new ideas.
Recent Improvements
- Antibiotic coatings: Fewer infections
- Better materials: Devices last longer
- More size options: Better fit for each person
- Adjustable pressure: Doctors can change settings without surgery
New Ideas Being Developed
- Smart sphincters: Control with your phone
- Magnetic systems: Simpler designs
- Tissue growth: Using cells instead of devices
- Smaller parts: Less invasive surgery
Dr. Michael Chen, a researcher, explains: “We’re entering an exciting time for artificial sphincters. Smart sensors and custom pressure settings will fix many problems with current devices.”
Other Treatment Options
The AUS isn’t right for everyone. Other options include:
Non-Surgical Approaches
- Pelvic exercises: Strengthen your muscles
- Bladder training: Learn to hold urine longer
- Pads and briefs: Absorb leaks
Other Surgeries
- Male slings: Simpler implants for mild leakage
- Bulking shots: Injections to tighten the urethra
- ProACT balloons: Adjustable balloons that press on the urethra
- Nerve stimulation: Electric signals to control bladder nerves
Comparing Choices
| Treatment | How Invasive | Works for Severe Cases | Need Good Hand Skills | How Long It Lasts |
|---|---|---|---|---|
| AUS | Very | Excellent | Yes | 7-10 years |
| Male Sling | Somewhat | Fair | No | Lifetime |
| Bulking Shots | Minimally | Poor | No | 6-18 months |
| ProACT | Somewhat | Fair | No | 3-5 years |
Special Cases
Children
Kids with birth defects need special care:
- Devices must allow for growth
- Controls may need to be simpler
- Family support is crucial
Women
Though less common in women, special factors include:
- Different placement options
- Higher risk of tissue damage in some cases
- Possible issues with pelvic organ sagging
Older Adults
Seniors may face extra challenges:
- Hand limits can make using the pump harder
- More health risks overall
- Balancing quality of life against surgery risks
Is an AUS Right for You?
When deciding about an artificial urinary sphincter, think about:
- How bad your leaking is and how it affects your life
- How other treatments have worked
- If you’re healthy enough for surgery
- If you can work the device
- What you expect from the results
- Who can help during recovery
Talk with a urologist who has done many AUS surgeries. Many medical centers can connect you with others who have the device to hear about their experience.
Common Questions
How long does an artificial urinary sphincter last?
Most work well for 7-10 years. Some last longer. Most people will need another surgery to replace or adjust it eventually.
Will insurance pay for an artificial urinary sphincter?
Most health plans, including Medicare, cover AUS when medically needed. Policies vary, so check with your insurance first.
How soon after prostate surgery can I get an AUS?
Most doctors suggest waiting 6-12 months after prostate surgery. This gives time for natural healing.
Can I have an MRI with an artificial urinary sphincter?
Most current AUS devices are MRI-safe under certain conditions. Always tell your healthcare team about your implant before getting an MRI.
Will the artificial urinary sphincter affect my sex life?
The device itself usually doesn’t affect sexual function. However, whatever caused your incontinence may have already affected your sexual health.
Can other people see the device?
The parts aren’t visible through clothes. You can feel the pump in the scrotum or labia, but others won’t notice it.
Conclusion
The artificial urinary sphincter has helped many people with severe urine leakage. For the right patients, it offers a chance to regain confidence and freedom from constant worry about accidents.
While it has some risks, modern AUS devices work well for many people who haven’t found help through other methods. As technology improves, we’ll see even better options in the future.
If you struggle with urine leakage, talk to a urologist about whether an AUS might help you. The right solution depends on your specific situation.