Surgery to place an artificial urinary sphincter (AUS) is an option for men with stress urinary incontinence or leakage of urine associated with coughing, sneezing, or straining. An artificial urinary sphincter consists of a cuff or ring that is placed around the urethra. There is a pump placed in the wall of the scrotum which can be manually squeezed. Upon squeezing the pump, fluid is shifted from the cuff to a balloon or reservoir that is placed behind the abdominal muscles. This movement of fluid allows the cuff to open; thus resulting in opening of the urethra and subsequent passage of urine. The cuff spontaneously closes as fluid returns from the reservoir to the cuff. When the cuff is closed, the urethra is compressed and leakage is generally eliminated or reduced to a minimum. Candidates for this type of surgery are generally men with moderate to severe urinary leakage such as those who have had prior prostate surgery. The AUS is placed through an incision in the perineum (space between the anus and the scrotum) as well as a small incision in the lower abdomen. The surgery can be performed with either a general or spinal anesthesia and patients typically spend one night in the hospital. A catheter placed at the time of surgery is removed on the day of discharge. At the time of the surgery, the cuff is locked in an open position so leakage will continue until the cuff is activated. Activation is achieved by firmly compressing the pump at around three weeks after surgery. Risks of the surgery include infection, bleeding, erosion of the cuff into the urethra, and incomplete control of incontinence.
About the Procedure
In men who have significant incontinence, the placement of an inflatable artificial urinary sphincter may be required. This procedure is usually performed under general anesthesia and takes between 2 and 3 hours. It can be placed through an incision at the base of the penis, or in the skin behind the scrotum (the perineum). Patients usually go home on the day of their surgery. Once the sphincter is in place and functioning, the patient releases the sphincter and empties the bladder by depressing a button hidden in the scrotum. Once urination is complete, the sphincter automatically closes, keeping the urine in the bladder and keeping the patient dry.
While the sphincter is designed to provide continence, it will not be ready for use until 6 weeks after its insertion. It should only be activated by your doctor. You should not expect to be dry immediately following your procedure. If you are dry immediately after the procedure, notify your doctor, as this may be a sign that the sphincter has been activated before it is ready for use.
Preparing for the Procedure
Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc).
Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Make arrangements for someone to drive you home on the day of your procedure.
After the Procedure
Some patients will require a catheter for a few days after their procedure. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears. While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house.