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How Does an Artificial Urinary Sphincter Work

Medically reviewed by Matt Coward, MD, FACS — By Daniel Yetman on October 4, 2022“Urinary incontinence” is the medical term for leaking urine. Research estimates that around 13 million people in the United States experience urinary incontinence, but the exact number varies depending on how it’s defined. Conservative methods, like controlling fluid intake or doing pelvic floor strengthening exercises, can usually treat mild urinary incontinence. If these methods don’t work, a doctor might recommend medications or surgery. Artificial urinary sphincter (AUS) surgery has been the gold standard treatment for severe urinary incontinence in men since the 1970s. An AUS is a device that contains an inflatable cuff around the tube that leads from your bladder out of your body, called the urethra. It comes with a hand-operated pump to release the cuff and allow urine to pass through. AUS surgery was originally developed for men who developed urinary incontinence after prostate removal. In recent years, an increasing number of AUS procedures have been used for other causes of urinary incontinence in men and women. Keep reading to learn more about the benefits of AUS, what to expect during the procedure, and potential risks.

Benefits of an artificial urinary sphincter

An AUS can effectively treat stress urinary incontinence. Stress urinary incontinence is when you leak urine when there’s increased pressure on your bladder during activities like:laughingsneezingcoughingexercise AUS surgery is the gold standard treatment for urinary incontinence after prostate removal. Research has consistently found that AUS is the most effective long-term treatment for men with severe urinary incontinence. AUS isn’t yet recognized as the gold standard for women, but it’s sometimes recommended when other treatments aren’t working. First-line surgical treatments for women often include methods of preventing drooping of the urethra, such as:mid-urethral slingstension-free vaginal tapetransobturator tape A 2020 review of 15 studies found AUS surgery can be an effective treatment option in women with severe urinary incontinence when these options don’t work.

Possible artificial urinary sphincter complications and precautions

The majority of people don’t experience any problems after an AUS procedure. The most common complication is urinary retention, or the inability to fully empty the bladder. A urinary catheter can usually manage this. Other complications can include:infectiondevice malfunctionblood in urinetearing of the urethrareaction to anesthesia during the procedurebleedingwasting of muscle in the urinary tractloss of bladder control AUS surgery can be extremely challenging in women, especially those who have had multiple anti-incontinence surgeries. Women have a high chance of needing reimplantation. Studies report revisional surgery rates from 32% to 45%.

Artificial urinary sphincter procedure

Here’s a general idea of what you can expect before and during AUS surgery.

Before the procedure

It’s important to tell your surgeon ahead of time about any medications or supplements you’re taking. Your surgeon may tell you to stop taking certain medications that interfere with blood clotting. An AUS surgery is performed under general anesthesia, so you’ll be asleep during the operation. Your surgeon will tell you how long before your surgery you’ll need to stop eating and drinking. You may be given medication before your operation procedure to make you sleepy. You may also have hair around the surgery site removed.

During the procedure

Here’s what will happen during your procedure:You’ll receive an anesthetic intravenously. The IV will be connected to a vein in your hand or arm.Once you’re asleep, a surgeon will make an incision in the space between your scrotum and anus if you have a penis, or your labia and anus if you have a vagina. They will make another incision in your lower abdomen.The surgeon will fit the device into place and close the wounds with stitches.

Artificial urinary sphincter surgery recovery

When you wake up, you’ll have a catheter in place to help you urinate. Most people can go home the day after their surgery. In the 24 hours after the procedure, you will have to avoid:drivingalcoholheavy mealsoperating heavy machinery Your surgeon will also likely instruct you to keep your wounds dry for a couple of days. You may have some soreness or bruising after your procedure. Applying ice can help reduce discomfort. The device needs to be deactivated for about 6 weeks after the operation. It’s generally recommended to avoid strenuous exercise or heavy lifting for about 4 weeks.

Artificial urinary sphincter surgery cost

In a 2018 Canadian study, researchers found the average 10-year cost of AUS implementation was $14,228. Most insurance providers, including Medicare and Medicaid, cover the cost of the AUS device and the surgery to implement it. However, it’s important to check your coverage ahead of time. Some parts of your treatment may not be covered. Medicaid coverage varies by state within federal guidelines. In a 2022 study using publicly reported data, researchers found AUS insertion was covered in 48 out of 49 states. All states reported coverage for removal with or without revision.

How to use an artificial urinary sphincter

An AUS comes with a hand pump to let urine pass through. For men, the pump is in the scrotum. For women, it’s placed in the labia. Squeezing the pump will release the cuff for approximately 2 to 3 minutes to allow you to urinate. It will close automatically after this time.Share on PinterestArtificial urinary sphincter (AUS). Illustration by Maya Chastain

Living with an artificial urinary sphincter

The only time you’ll need to interact with the device is when you squeeze the pump to urinate. It’s important to go to all your scheduled follow-ups to make sure the device is functioning properly. AUS devices eventually need to be replaced, but they can last for many years. AUS devices are compatible with MRIs, but it’s still a good idea to let healthcare professionals know ahead of time that you have one.

Other treatments for male urinary incontinence

Other treatments for male urinary incontinence include:

Lifestyle changes

Mild incontinence may be treated by:limiting fluid intake, especially before bedcutting back on caffeine and alcohollosing weight if neededbladder training

Pelvic floor exercises

Your pelvic floor muscles control the flow of urine when you go to the bathroom. Your doctor may refer you to a specialist for pelvic floor muscle training.

Electrical stimulation

Electrical stimulation of your bladder may help restore your ability to control the urge to urinate as well as incontinence. Sacral nerve and tibial nerve stimulation are two techniques that may be used.

Medications

Medications used to treat urinary incontinence include:anticholinergicsalpha-blockersmirabegronbotulinum toxin type A

Bulking agents

Bulking agents are injected around your urethra to put pressure on it and help it close. Some studies have reported encouraging short-term results in men.

Sling procedure

Another surgical option is a sling procedure. In this procedure, a pouch is made from a synthetic material to support the bladder and help the urethra stay closed. Like with AUS surgery, it’s generally only performed when other treatments don’t work.

Frequently asked questions

Here are some frequently asked questions people have about AUS surgery.

When can you resume normal activity following AUS surgery

You’ll likely be able to return to most of your light activities within a couple of days after your procedure. It’s a good idea to wait at least 4 weeks after your procedure to perform strenuous exercise or heavy lifting.

What is the success rate for AUS procedures

Success rates for AUS procedures range from 59% to 90%. They generally have high levels of satisfaction.

How long does an AUS last

AUS devices wear out over time. Studies have found the average AUS life span is between 4.6 and 12.7 years.

Can you deactivate an AUS

AUS devices come with a deactivation button. The device will be deactivated for about the first 6 weeks after your procedure. It will also need to be deactivated before you have a catheter fitted into your urethra.

Takeaway

An AUS is a device that’s used to treat urinary incontinence. It contains a cuff that prevents urine leaking and a hand pump in your scrotum or labia that releases the cuff and allows you to urinate. AUS surgery is the gold standard treatment for severe stress urinary incontinence in men. It’s becoming a more popular treatment for women. Your doctor may recommend an AUS if more conservative treatments don’t work. Last medically reviewed on October 4, 2022

How we vetted this article

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ncbi.nlm.nih.gov/pmc/articles/PMC6747852/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 4, 2022 By Daniel Yetman Edited By Roman Gokhman Medically Reviewed By Matt Coward, MD, FACS Copy Edited By Sara Giusti Share this articleMedically reviewed by Matt Coward, MD, FACS — By Daniel Yetman on October 4, 2022

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