If you struggle with male urinary incontinence then you’re in the right place. We understand how debilitating stress incontinence can be in everyday life. You may already be considering an Artificial Urinary Sphincter (AUS) and have some questions about whether it would be right for you and your symptoms, how an AUS works, what the procedure involves and the likely recovery process.
This article will answer the top 10 questions our patients tend to have about Artificial Urinary Sphincters, answered by our expert healthcare professionals.
How do I know if I am a candidate for the Artificial Urinary Sphincter?
The AUS is a treatment option for patients who struggle with refractory stress incontinence. There are generally 2 types of incontinence, urge incontinence (when the bladder is overactive, leading to often getting to the toilet too late) and stress incontinence (when the pelvic floor is not strong enough to withstand types of pressure from the bladder and abdomen, leading to urine loss).
An AUS is a possible treatment option for stress incontinence that is not improved with pelvic floor exercises. Examples of symptoms of stress incontinence could be losing urine whilst:
- Exercising e.g. lifting weights, jumping, running
- Coughing or sneezing
You may have noticed these symptoms appear after having prostate surgery which is unfortunately quite common. In these scenarios, the sphincter muscle in the pelvic floor is not strong enough to keep urine inside the bladder, resulting in urine loss.
When pelvic floor exercises are not enough to improve severe incontinence symptoms, an Artificial Urinary Sphincter would be a treatment option to consider.
How does the Artificial Urinary Sphincter work?
The Artificial Urinary Sphincter is a simple, mechanical device that mimics the actions of our own urethral sphincter. Essentially, it compresses or squeezes the urethra to prevent urinary leakage much like the real sphincter would do.
The device itself consists of three parts; a plastic cuff that sits around the urethra, a pump that sits beneath the skin of the scrotum, and a small pressure regulating balloon (which sits ion the abdomen).
The cuff is not inside the tube itself but sits around the urethra, compressing it. Inside the cuff there is an amount of fluid (saline, salty water) pressing on the urethra.
The second component is the pump. In male patients, the pump sits in the skin underneath the skin of the scrotum and can be felt through the skin. It is about 2cm long and 1cm wide, so it is quite small and discreet. In women it sits in the skin of the labia.
When the patient presses on the pump, it empties the cuff of the saline solution into the balloon. This relieves the pressure on the urethra, enabling the bladder to empty.
After the patient has passed the urine, the fluid in the pressure regulating balloon pushes the fluid back into the cuff and compresses the urethra again.
This nifty mechanical device has been around for nearly 50 years and utilises the simple mechanical principles of pressure to allow patients to regain urinary control.
Can I choose the type of AUS I receive?
There are several types of AUS available, produced by different manufacturers.
The choice depends on your medical needs and other factors such as whether an alternative treatment is possible or whether you have undergone surgery before.
It’s important to discuss with your doctor the advantages and disadvantages of each system and ascertain which is the best option for your individual needs.
Will the AUS be noticeable to others?
It’s understandable that you may be worried about the device being noticeable to other people. The simple answer is no, it shouldn’t be very noticeable to other people.
As we discussed above, there are 3 components to the AUS device:
- The cuff that goes around the urethra is inside the body and is not noticeable at all.
- The balloon is within the lower abdomen, so inside the body and not noticeable.
- The pump needs to be worked by the patient, so needs to be felt to use it, however it is not visible from the outside.
This information should help ease any doubt you may be feeling in regard to the device being noticeable as it is well concealed.
What should I discuss with my doctor before getting an AUS?
It’s important to discuss the severity of your incontinence and whether surgery is necessary, especially if there are other medical conditions to consider alongside such as diabetes, high blood pressure or smoking related conditions.
Alternative treatments like male slings may be an option for mild cases. It’s also important to understand the risks, such as infection or device failure, and ensure any insurance covers the procedure, as costs can vary.
How do I prepare for AUS surgery?
As the procedure involves implanting a foreign body into your body, the most important thing is that the body does not reject it. The biggest reason for rejection in most cases is through infection.
The infection rate is higher in smokers than non-smokers, so a good way to prepare for the surgery is to stop smoking to give your body the best chance at healing effectively.
If you have conditions such as diabetes or high blood pressure then you should talk to your doctor about wanting the Artificial Urinary Sphincter surgery, and how best these conditions can be managed in the lead up to the procedure.
Working closely with your healthcare professionals and heeding advice on condition management gives you the best chance of success and effective recovery.
What can I expect during recovery from AUS surgery?
The operation to implant the Artificial Urinary Sphincter is usually done under a general anaesthetic and takes about an hour to 90 minutes. Sometimes the patient will be allowed home the same day, other times they may be asked to stay overnight.
Typically, a catheter would be inserted for the surgery and removed afterwards or perhaps the next day.
The key thing for patients to know is that the device does not work immediately following the surgery. After the artificial sphincter has been inserted, it is left deactivated to let the body get used to it.
Patients will still be incontinent for a period following the surgery so will need to use pads or whatever they were using to manage it before. This is usually for about 6 weeks post-surgery.
In terms of physical recovery, we liken the procedure to hernia surgery. For the first week, you shouldn’t do too much too soon and stay within the house. As we mentioned above, many patients have already had prostate surgery and can be in their 70’s or 80’s so healing does take time and patience is needed. Activity levels in the first 2 weeks should be low.
After 2 weeks, you can start to do walks and get out and about a bit more, slowly building up their physical activity. Heavy lifting of any kind needs to wait until after 6 weeks post surgery.
In terms of post-operative care, a phone call or meeting with the patient will happen after about 2 weeks to check in on recovery and look at the wound.
After about 6 weeks, the patient is brought back in and the device is activated – And hopefully we see continence! For the vast majority of patients, the surgery is a success and they are dry.
Can I still engage in physical activities with an AUS?
The aim of this surgery is to restore your lifestyle back to what it was before incontinence became a problem or perhaps prior to having prostate surgery.
When incontinence interferes with everyday life, patients reduce their expectations accordingly. You may no longer be able to go and play golf, sail or have sex, for example, due to leakage. The aim of surgery for an Artificial Urinary Sphincter is to help restore your expectations to what they had beforehand.
There are, however, a few exceptions due to where the AUS is placed. The artificial sphincter cuff sits in the perineum. Most people have very little tissue between the perineum and urethra, and hence the cuff as well. As the cuff is fluid filled plastic, efforts need to be made to ensure it doesn’t pop. This means any pursuits that are saddle related need to be considered carefully, for example, if you are a keen cyclist you may need to invest in a cut-out seat so there is no pressure on the perineum.
Patients will also need to be careful sitting down, especially on hard chairs. They should lower themselves gently into a sitting position to get the greatest number of years out of the AUS as possible.
How long does an AUS last, and what is the likelihood of needing a revision?
An AUS typically lasts ~ 10 years, but about 30% of patients may need revision surgery within five years due to mechanical issues or urethral atrophy. By 10 years, 50% of devices are still functioning. Revision surgeries are common but generally straightforward.
Can I have an MRI with an Artificial Urinary Sphincter?
Yes, the AUS is safe for MRI scans. These devices are MRI-conditioned, meaning they’ve been tested and approved for use with MRI machines. Patients can safely undergo MRI exams, even those with high-powered scanners, without any issues.
It’s worth noting that whilst an MRI is safe to do with an AUS, not all procedures are. For example, procedures like a cystoscopy or catheterisation have to be done very carefully in th presence of AUS, to avoid damage to the cuff or urethral erosion. It’s vital that a patient who has an AUS informs future doctors, like a urologist or if they were admitted to A and E, that they have an AUS which must be deactivated before any procedure affecting the urethra.
Get in Touch with our Expert Team of Urologists
Here at the London Men’s Clinic, we have a team of highly trained and nationally recognised urologists who offer state-of-the-art urological care in a warm, caring and patient focused setting.
We know that urinary incontinence can really impact your life and we are here to help. If you are experiencing any of the symptoms of stress incontinence outlined above and would like to make an appointment to discuss Artificial Urinary Sphincter treatment options then please get in touch with us today.
To read reviews from patients who have had an AUS with London Men’s Clinic please click here.