Artificial Urinary Sphincter for Urinary Incontinence

Prostate cancer is a prevalent and quite treatable concern. When caught early and found to be low grade, the saying goes that most men will die WITH prostate cancer rather than OF it. With that said, this does not mean that prostate cancer is no big deal. To be sure, low to intermediate-grade prostate cancer may not grow fast enough to be a significant concern (though it must actively be monitored), but the small percentage of cases that involve high-grade prostate cancer can be deadly and require urgent intervention in the form of prostatectomy or prostate removal and/or radiation. 

However, removing or radiating the prostate can cause severe symptoms, up to and including urinary incontinence and erectile dysfunction. Patients should expect both conditions for at least some time after treatment. For many, erectile function returns within about a year. For 95% of people, urinary continence returns within a year and a half to two years. However, for some, there may be a continence deficit that is either mild, moderate, or severe. Patients with mild to moderate urinary incontinence often qualify for a male sling, an excellent solution with exceptional outcomes and patient satisfaction results. For those with more severe incontinence, Dr. Natale usually suggests an artificial urinary sphincter.

What is an Artificial Urinary Sphincter?

An artificial urinary sphincter, or AUS, is a multi-piece medical device that controls urine leakage using a compression cuff around the urethra. The device comprises three main pieces, like its cousin, the penile implant. The first component is the cuff itself, which is wrapped around the urethra during surgery. Second is a pump placed in the scrotum that draws liquid from the cuff to a reservoir placed in the pelvis, the third piece of the device. Unlike a penile implant, which inflates when the pump is activated, the urinary cuff is deflated to allow for urination – about 3 minutes’ worth. Over that time, the cuff refills with water and once again clamps off the urethra so urine cannot pass.

The AUS is typically implanted in a hospital or surgery center during an hour-long procedure. After this point, they recover for a couple more hours in the postoperative area and go home the same day, unless they are at risk for complications. Patients are sent home with a catheter that is removed the next day. The AUS is left uninflated for some time as the body heals from surgery. After this time, with a visit to Dr. Natale, the device is finally deployed, and patients have complete control over their urinary habits.

How Long Does the AUS Last

Improvements in technology and materials used in artificial urinary sphincters have improved to such a degree that patients are most often thrilled with their AUS. With proper usage, the device can last a decade or more, offering many men a leak-free future. Of course, the device may fail; however, if it no longer provides the structure to cut off urine flow, the cuff can be replaced with an easy follow-up procedure.

Potential Concerns of an AUS

Of course, we are concerned about infection as with any surgery, especially those requiring an implanted medical device. Infection rates with these implants have dropped precipitously over the years as improvements and antibiotic coatings have helped minimize these concerns. In addition to the rare circumstance of an infection, the cuff may erode into the urethra, requiring removal and reimplantation with a new device. Fortunately, this happens very infrequently.

The Bottom Line

Many men wait years or even decades to treat the urinary incontinence caused by their prostatectomy. As such, patients are frustrated yet hopeful when they first meet Dr. Natale. The truth is that with the advent of the artificial urinary sphincter, men can manage their urinary habits with an excellent treatment option that is discreetly hidden within the body.

The AUS or artificial urinary sphincter is an excellent treatment option for patients with severe or moderately severe urinary incontinence and for whom a male sling would not be appropriate. Satisfaction rates top 90%, primarily because of the transformative nature of the surgery. Seeing a man’s urinary health, and by extension, his confidence, improve is one of the most gratifying parts of a urologist’s practice. 

The next step is to contact a men’s health specialist like Dr. Natale to learn more about the male sling or artificial urinary sphincter for continence after prostatectomy or radiation. We look forward to helping you, as we have for hundreds of other patients who wanted to regain their continence and return to what they love.