Why Does Urinary Incontinence Occur?
Leakage of urine is very common following surgery for prostate cancer (radical prostatectomy). The surgery often leads to damage to nerves and muscles used for urinary control. Mild incontinence occurs in about 20% of men following prostatectomy, while a small minority of patients experience severe leakage.
Artificial urinary sphincter (AUS)
An artificial urinary sphincter (AUS) is an implantable device that allows men with incontinence to regain urinary control. The device consists of a cuff that goes around the urethra, a pump in the scrotum, and a balloon in the pelvis. The cuff remains closed in its default state and when the patient wants to void, he squeezes the pump in the scrotum, which opens up the cuff, allowing the patient to urinate. After about a minute, the cuff automatically refills with fluid in order to regain continence.
Artificial Urinary Sphincter FAQs
The surgery is performed under general anesthesia in our ambulatory surgery center (ASC) as a day surgery and takes approximately 90 minutes. Two incisions are made, one in the perineum and another in the groin.
Common risks include pain, swelling, and bruising/bleeding. Although quite rare, more serious complications include infection of the device and urethral erosion. The AUS is a foreign body and if it gets infected, it needs to be removed and replaced. Infection rates are around 1%. The AUS contains a special antibacterial coating to help prevent infection. In order to minimize infection, we use many techniques before, during, and after the operation.
Men who have undergone radiation therapy for prostate cancer are at higher risk for the device eroding into the urethra. If this occurs, the device needs to be removed and can be replaced after the urethra heals. It is important to tell other health care providers that you have an AUS. If you ever need a urinary catheter placed, the device must be deactivated so the cuff is not injured.
Studies have shown that patient satisfaction rates are over 90%. Depending on the severity of leakage prior to surgery, some patients may still have small amounts of leakage after surgery. Nonetheless, most patients describe it as life-changing.
Yes, the AUS is MRI-safe.
The AUS is a mechanical device that may stop working at some point. They usually last 7-10 years, but could last much longer. When and if they fail, the device can be removed and replaced with a surgery very similar to the original operation.
It is important to find a urologic surgeon who is fellowship-trained in prosthetic surgery. We recommend patients ask about the experience level of the surgeons performing AUS implants and only go to someone who is comfortable with all aspects of the case.
You will first undergo an evaluation with our urologist to determine if you are a suitable candidate for an AUS. The work-up may include a history, physical exam, cystoscopy (looking inside the urethra and bladder with a small camera), urine flow studies, labs, and urine tests. This work-up can be performed all on the same day.
Most insurances companies cover the device and surgery. For those without insurance, we have specialists who can work with the patient on costs and payment.