Introduction

Regaining control after prostate surgery? If you’re experiencing post-prostatectomy urinary incontinence, an artificial urinary sphincter (AUS) could be a minimally invasive surgical solution to help you regain bladder control.

How Artificial Urinary Sphincter Work?

An artificial urinary sphincter (AUS), also sometimes referred to as an inflatable artificial sphincter, acts like an internal security guard for your bladder, helping to manage urinary incontinence by regulating urine flow. Here’s a breakdown of how this medical device functions:

The Components:

Imagine a three-piece system working together:

  • Urethral Cuff: This cuff wraps around the urethra, the tube that carries urine from the bladder to the outside of the body. When filled with fluid, the cuff squeezes the urethra shut, preventing any leakage of urine.
  • Reservoir: This balloon-like pouch, also known as a fluid reservoir, sits discreetly implanted in your lower abdomen. It stores the sterile fluid that is used to inflate and deflate the cuff.
  • Pump: This small pump is placed in a discreet location, either in the scrotum for men or in the labia majora for women. The pump controls the flow of fluid between the cuff and the reservoir.

The Mechanism:

  • Constant Guard: By default, the cuff remains filled with fluid from the reservoir. This keeps the urethra compressed and prevents urinary incontinence.
  • Time to Empty: When you need to urinate, you gently squeeze the pump. This action pushes the fluid from the cuff back into the reservoir.
  • Open Sesame: With the cuff deflated, the urethra opens, allowing urine to flow freely when you empty your bladder.
  • Automatic Refill: The beauty of the AUS system lies in its clever design. After a few minutes, typically between 3-5 minutes, the cuff automatically refills with fluid from the reservoir. This ensures continence is restored.

Benefits:

An AUS implantation can offer a significant improvement in quality of life for people dealing with severe urinary incontinence. It provides a reliable and effective way to manage leaks.

Things to Consider:

An AUS is a surgical procedure, so it’s important to consult with a urologist, a medical professional specializing in the urinary system, to understand if it’s the right treatment option for you. There will be post-surgical recovery steps to follow, and while highly effective, AUS is not a complete cure for incontinence. However, it can significantly enhance your ability to control your bladder and improve your daily activities.

5 Advantages of Artificial Urinary Sphincter:

  • High Success Rates: An artificial urinary sphincter (AUS), also sometimes called an inflatable artificial sphincter, is considered the gold standard treatment for post-prostatectomy incontinence. Success rates are reported to be well over 90%, meaning a large majority of patients experience significant improvement or complete resolution of urinary leakage (involuntary urine loss) after AUS implantation.
  • Improved Quality of Life: Regaining urinary control can dramatically improve a man’s quality of life. With an AUS, men can participate in activities they may have previously avoided due to incontinence, such as exercise, travel, and social gatherings.
  • Long-Term Durability: Modern AUS devices are engineered for durability and can last for many years. While some complications may necessitate explantation (removal) or revision surgery, most patients can expect their AUS to function effectively for a long time.
  • Adjustable Continence: AUS devices are equipped with a pump mechanism that allows the user to control the level of continence. This enables customization based on individual needs and activities. For instance, some users might prefer a higher level of continence for activities like exercise, while opting for a slightly looser setting for situations where urination is more frequent.
  • Greater Patient Satisfaction: Studies consistently show that patients tend to report high satisfaction rates after AUS implantation. The ability to regain control over urination can significantly improve a man’s confidence and self-esteem.

What is the best artificial urinary sphincter?

There isn’t a single “holy grail” when it comes to artificial urinary sphincters (AUS). Different devices may be a better fit for certain patients depending on various factors. However, the AMS 800™ Artificial Urinary Sphincter is widely regarded as the gold standard due to its impressive track record:

  • Extensive Experience: With over 250,000 devices implanted since its development in 1972, the AMS 800 boasts a long history of successful use in treating urinary incontinence.
  • High Success Rates: Studies consistently report success rates exceeding 90%, meaning a large majority of patients experience significant improvement or complete resolution of involuntary urine leakage (incontinence) after AUS implantation.
  • Long-lasting Durability: Modern AMS 800 devices are engineered for durability and can function effectively for many years.
  • Adjustable Continence: A user-friendly pump mechanism allows for customization of continence levels based on individual needs and activities.

Factors to Consider When Choosing an AUS:

While the AMS 800 is a strong contender, here are some other important considerations when choosing an artificial urinary sphincter:

  • Your Specific Anatomy and Incontinence Severity: The type and severity of your incontinence, along with your unique anatomical factors, will influence which AUS device is most suitable for your situation. A urologist, a medical professional specializing in the urinary system, can assess your individual needs and recommend the most appropriate AUS option.
  • Surgeon’s Expertise and Preference: Surgeon experience and preference can also play a role. Discuss your AUS options with a urologist who has a proven track record of successful AUS implantations. They can advise you on the devices they have the most experience with and feel would be the best fit for your specific case.
  • Insurance Coverage: Insurance coverage for AUS implantation can vary depending on your provider and plan. It’s important to check with your insurance company beforehand to understand your coverage details and any potential out-of-pocket costs associated with the procedure and the specific AUS device chosen.

When is an Artificial Urinary Sphincter (AUS) Necessary?

Artificial urinary sphincters (AUS) are implanted to treat moderate to severe urinary incontinence, a condition marked by involuntary leakage of urine that significantly disrupts daily life. Here are some specific scenarios where a doctor might recommend AUS surgery:

  • Severity of Leakage: If you experience frequent or large leaks of urine that interfere with your daily activities, social interactions, or sleep, an AUS can provide a surgical solution to regain control. Significant leaks can be emotionally distressing and limit your ability to participate in daily life.
  • Unsuccessful Conservative Treatments: If you’ve tried conservative measures like lifestyle changes, pelvic floor muscle exercises (Kegels), or medications and haven’t seen sufficient improvement in your incontinence, AUS may be a viable next step.
  • Type of Incontinence: AUS is most commonly used for stress incontinence, where urine leaks due to pressure on the bladder during activities like coughing, laughing, or exercise. It can also be helpful for some cases of mixed incontinence (a combination of stress and urge incontinence). Urge incontinence is the sudden and involuntary need to urinate, even when the bladder isn’t full.

Important Considerations:

The decision to implant an AUS is made collaboratively between you and your doctor. They will carefully evaluate the severity of your incontinence, your overall health, and whether you’re a suitable candidate for surgery.

Artificial Urinary Sphincter Implantation Process

An artificial urinary sphincter (AUS), also sometimes referred to as an inflatable artificial sphincter, implantation is a surgical procedure for moderate to severe urinary incontinence, a condition where you experience involuntary leakage of urine that significantly disrupts your daily life. Here’s a breakdown of the general process to help you understand what to expect:

Before Surgery:

  • Consultation: You’ll have a consultation with a urologist, a medical professional specializing in the urinary system. During this appointment, you’ll discuss your incontinence symptoms, medical history, and whether an AUS is a suitable treatment option for you.
  • Tests: Your urologist may recommend tests like a urodynamic evaluation. This test assesses how well your bladder stores and releases urine, and can help identify any underlying causes of your incontinence.
  • Blood Work and Imaging: Blood tests and imaging studies, such as X-rays or ultrasounds, may be needed to check your overall health and ensure you are fit for surgery.
  • Medications: Certain medications, such as blood thinners, may need to be adjusted or stopped before surgery to minimize bleeding risks.

The Surgical Procedure:

  • Anesthesia: General anesthesia or spinal anesthesia is typically used to keep you pain-free and comfortable during the surgery.
  • Incisions: The surgeon will make one incision in your lower abdomen (belly) to place the reservoir, and another incision in the perineum (the area between the scrotum and anus in men, or labia majora in women) to implant the cuff and pump.
  • Implantation: The three components of the AUS – the cuff, reservoir, and pump – are then implanted and connected. The cuff is placed around the urethra, the tube that carries urine from the bladder out of the body. The reservoir, a balloon-like pouch containing sterile fluid, is positioned in your abdomen. The pump, a small device that allows you to control the AUS, is discreetly placed in the scrotum (for men) or labia majora (for women).
  • Catheter Placement: A urinary catheter, a thin tube inserted into the bladder to drain urine, will likely be placed for the first 1-2 days after surgery to allow healing.

After Surgery:

  • Hospital Stay: AUS implantation is often an outpatient procedure, meaning you may go home the same day after surgery. In some cases, you may need to stay overnight in the hospital for observation.
  • Recovery: You can expect some pain and discomfort in the incision areas for a few days after surgery. Your doctor will prescribe pain medication and provide pain management strategies to help you feel comfortable during recovery.
  • Catheter Removal: The urinary catheter is usually removed within a day or two after surgery.
  • Restrictions: You may have some activity limitations for a period of time to allow the incision sites to heal properly. Your doctor will provide specific instructions on activity restrictions.
  • Activating the AUS: Your doctor will instruct you on how to use the pump to activate and deactivate the AUS device. The pump controls the flow of fluid in the AUS system, allowing you to control urination.
  • Recovery Timeline: Full recovery from AUS implantation can take several weeks. Be patient with your body and follow your doctor’s instructions for proper care and rehabilitation exercises to promote healing.

Additional Considerations:

  • While AUS implantation can significantly improve urinary incontinence, it’s not a permanent solution. Long-term complications like device malfunction or erosion can occur in some cases and may require additional procedures.
  • It’s important to discuss the potential risks and benefits of AUS implantation with your urologist to determine if it’s the right course of treatment for you.

Recovery Timeline After Artificial Urinary Sphincter (AUS) Implantation

Following an AUS implantation to treat urinary incontinence, recovery involves several stages. It’s important to remember that this is a general guideline, and individual healing experiences can vary depending on several factors, including your overall health, the complexity of the surgery, and how well you follow your doctor’s post-surgical instructions.

Immediately After Surgery (1-2 Days):

  • Hospital Stay: You’ll likely be in an outpatient setting or stay overnight for observation.
  • Pain Management: Expect some pain and discomfort around the incision sites. Pain medication will be provided to manage this discomfort.
  • Urinary Catheter: A urinary catheter, a thin tube inserted into the bladder to drain urine, will likely be placed for a day or two to allow the surgical area to heal initially.

The First Week:

  • Catheter Removal: The catheter is typically removed within 1-2 days after surgery.
  • Pain Resolution: You’ll experience some soreness and discomfort, but pain should gradually decrease.
  • Activity Restrictions: Your doctor will likely advise activity restrictions to promote healing. Strenuous activities and heavy lifting should be avoided for at least a week, or as instructed by your doctor. This is to allow the surgical sites to heal properly and minimize complications.
  • Learning to Use the AUS Pump: An important part of recovery is learning how to use the pump to activate and deactivate the AUS device. Your doctor or a healthcare professional will provide instructions on proper pump usage.

Weeks 2-4:

  • Reduced Discomfort: Discomfort should continue to subside as your body heals from the surgery.
  • Gradual Return to Activity: Activity restrictions may be gradually eased as your doctor advises. This process should be tailored to your individual progress.
  • Follow-Up Appointments: You’ll likely return for follow-up appointments to monitor healing and adjust the AUS device if needed. These appointments are crucial to ensure the AUS is functioning properly and to address any potential concerns you may have.

Weeks 4-8:

  • Improved Mobility: Most of the pain and discomfort should be resolved by this point. You should be able to resume most normal activities, but strenuous exercise may still be restricted. Your doctor will advise you on a safe timeline for gradually returning to your exercise routine.
  • Continued Monitoring: Continued follow-up appointments with your doctor are crucial to monitor the device and address any potential issues. Even though you may be feeling back to normal, regular check-ups are important for the long-term success of the AUS.

Full Recovery (6-12 Weeks):

  • Complete Healing: It can take up to 3 months for complete healing and for the AUS device to fully integrate with your body tissues.
  • Return to Normal Activities: By this time, you should be able to resume all activities without limitations.
  • Long-Term Follow-Up: Regular follow-up appointments with your doctor are still important to monitor the device and address any potential issues. Early detection and treatment of any complications can help ensure the long-term success of your AUS implant.

Possible Risks of Implantation of an Artificial Urinary Sphincter?

While artificial urinary sphincter (AUS) surgery is a successful treatment for many people with urinary incontinence, there is a possibility of complications. It’s important to understand these potential risks and discuss them with your doctor to make an informed decision about whether AUS is the right treatment option for you. Here’s a breakdown of some potential issues, ranging from common to rare:

  • Minor Leaking or Dribbling: This is the most frequent occurrence, especially during physical activity. Some leakage may still occur with an AUS, particularly when engaged in activities that put stress on the bladder, such as coughing, laughing, or exercise.
  • Persistent Incontinence: In some cases, the AUS implant may not completely resolve incontinence. This could be due to various factors, and your urologist can discuss the likelihood of this based on your specific situation.
  • Need for Additional Surgery: Complications like device malfunction, infection, erosion (where the AUS rubs through surrounding tissue), or bleeding might necessitate further surgery to correct the problem. While AUS is a durable device, it’s not a lifelong solution, and some people may require additional procedures over time.
  • Infection: Infection in the AUS device itself, the surgical wounds, or the urinary tract can occur. Antibiotics would be necessary to treat an infection.
  • Urinary Retention: This refers to the inability to urinate after the urinary catheter is removed. It might require a temporary recatheterization (reinserting the catheter) or a suprapubic catheter (inserted through the lower abdomen).
  • Severe Scrotal Swelling and Pain: This can be a serious complication, and you should seek immediate medical attention if you experience this after surgery.
  • Urethral Injury: Injury to the urethra, the tube that carries urine from the bladder, might necessitate stopping the procedure, using a temporary catheter to allow the urethra to heal, and potentially repeating the surgery later.

Very Rare Complications:

  • Bladder Injury: This requires surgical repair and is a very uncommon complication.
  • Incisional Hernia: A bulge may develop at the incision site, but this is also rare.
  • Anesthetic Risks: While not listed here in detail, there are inherent risks associated with anesthesia that you should discuss with your doctor.

Alternatives to Artificial Urinary Sphincter (AUS) Implantation

If you’re considering treatment for urinary incontinence, an AUS implant is one option, but it’s not the only one. There are various treatment approaches available, and the most suitable option for you will depend on several factors, including the severity and type of your incontinence, your overall health, and your treatment preferences. Here’s an overview of some alternative treatment options:

Non-Surgical Treatments:

  • Pelvic Floor Muscle Exercises (Kegels): These exercises strengthen the pubic floor muscles, which provide support for your bladder and urethra. Strengthening these muscles can improve your ability to control urination.
  • Lifestyle Changes: Making some simple lifestyle adjustments can significantly reduce incontinence episodes. This may involve managing your fluid intake, reducing consumption of caffeine and alcohol (which can irritate the bladder), and quitting smoking (which can weaken the pelvic floor muscles).
  • Bladder Training: Bladder training involves techniques to retrain your bladder to hold urine for longer periods. This may involve strategies like scheduled urination and delaying urination urges.
  • Medications: Certain medications can be helpful for urinary incontinence. For example, some medications relax the bladder muscles, while others decrease urine production. Your doctor can discuss which medication might be appropriate for your specific type of incontinence.

Minimally Invasive Procedures:

  • Urethral Bulking Agents: These are injectable materials that add bulk to the tissues surrounding the urethra, helping it close more effectively and prevent urine leakage.
  • Slings: These are synthetic mesh supports that are inserted through minimally invasive surgery to provide additional support for the urethra and bladder neck. There are different types of slings available for men and women.

Surgical Procedures (for Women):

  • Colposuspension: This surgical procedure tightens the pelvic floor muscles and ligaments to improve bladder support and address incontinence.
  • Anterior Prolapse Repair: This surgery repairs a condition called cystocele, where the bladder bulges into the vagina. This bulging can contribute to urinary incontinence in some women.

Choosing the Right Treatment:

The best course of treatment for you will be determined by a consultation with your doctor. They will consider the following factors:

  • Severity of Incontinence: For mild to moderate incontinence, non-surgical or minimally invasive approaches may be sufficient.
  • Type of Incontinence: The type of incontinence you experience (stress, urge, or mixed) will influence the treatment choices your doctor recommends.
  • Overall Health: Your overall health and suitability for surgery will be considered to ensure you are a good candidate for any procedures being discussed.
  • Your Preferences: Discuss your desired level of treatment invasiveness and your expected outcomes with your doctor. They can help you weigh the pros and cons of each option to arrive at the best treatment plan for you.

Conclusion

Urinary incontinence, the involuntary leakage of urine, can be a significant challenge, especially for men who have undergone prostate surgery. If you’re experiencing post-prostatectomy incontinence and traditional treatments like lifestyle changes, pelvic floor muscle exercises (Kegels), or medications haven’t provided adequate relief, an artificial urinary sphincter (AUS) implant may be a viable option to discuss with your urologist.

An AUS is a surgically implanted device that acts as an artificial sphincter, a ring-like muscle that controls the flow of urine from the bladder. Implantation is a surgical procedure, but for many men with severe stress incontinence, an AUS offers a reliable and effective solution to regain bladder control.

Here are some key takeaways about AUS:

  • Effective for Severe Stress Incontinence: If you experience significant urine leakage during activities like coughing, laughing, or exercise, an AUS can significantly improve your continence.
  • Consultation with a Urologist: AUS implantation is not right for everyone. Discuss your incontinence symptoms and treatment options with a urologist to see if you’re a good candidate for AUS surgery.
  • Improved Quality of Life: With a successful AUS implantation, you can regain control of your bladder and return to the activities you enjoy without fear of leakage.

Categorized in:

Urology,

Last Update: 6 April 2024