Artificial Urinary Sphincter

What is an artificial urinary sphincter?

An artificial urinary sphincter (AUS) is an inflatable medical device that helps treat uncontrollable urinary leakage (incontinence). A surgeon (urologist) places the device around your urethra. The artificial urinary sphincter contains fluid, which keeps it inflated. This holds urine (pee) in your body. When you’re ready to use the bathroom, you squeeze a pump in your scrotum. The pump will deflate the AUS and allow pee to flow out. The device will inflate automatically after about three minutes.

Another name for an artificial urinary sphincter is an artificial urethral sphincter.

What is a urinary sphincter?

A urinary sphincter is a muscle that acts as a valve. When it works as expected, it stays closed (contracted) to keep pee in your body. When you’re ready to pee, it relaxes to let pee through.

You have two different urinary sphincters:

• Internal urethral sphincter. This connects to the end of your urethra that attaches to your bladder (urinary bladder). When it relaxes, pee passes from your bladder to your urethra. It mostly consists of the narrow outlet at the bottom of your bladder (bladder neck) and your prostate.
• External urethral sphincter. This is in your pelvic floor muscle. When it relaxes, pee flows through your urethra and out of your body.

If these muscles aren’t strong enough, they let pee through before you’re ready to use the bathroom, especially when you cough, sneeze or jump (stress incontinence). An AUS helps do the job of these muscles.

What does an artificial urinary sphincter treat?

Healthcare providers typically use an artificial urinary sphincter to treat stress urinary incontinence in people assigned male at birth (AMAB) who don’t respond to other treatments, including medications and bladder training. In people AMAB, stress incontinence may occur after prostate cancer surgery (prostatectomy). It causes you to leak pee during certain movements or activities, including:

• Laughing.
• Sneezing.
• Coughing.
• Walking.
• Exercising.

Providers rarely use an AUS to treat stress incontinence in people assigned female at birth (AFAB).

How does an artificial urinary sphincter work?

An artificial urinary sphincter consists of three parts:

• Pressure balloon. A urologist inserts the balloon under your abdominal (stomach) muscles. The balloon pushes fluid at a constant pressure that keeps your urethra closed.
• Urethral cuff. The cuff fits around your urethra. The cuff is always filled with fluid. This fluid squeezes tightly around your urethra, similar to how a blood pressure cuff squeezes your arm during a physical exam, and keeps you from leaking urine.
• Pump. In people AMAB, the urologist inserts the pump into the pouch of skin behind your penis that holds your testicles (scrotum) or the space between your rectum and genitals (perineum). In people AFAB, the urologist usually inserts the pump in your outer labial lips or folds (labia majora). The pump controls the movement of fluid through the AUS.

To activate an AUS, you use your hand to squeeze the pump when you feel the need to pee. Squeezing the pump moves the fluid in the AUS from the urethral cuff into the pressure balloon. Without any fluid, the cuff expands, which allows pee to flow from your bladder, through your urethra and out of your body. After a few minutes, the balloon pushes the fluid back into the urethral cuff, closing off your urethra and preventing leakage.

What are the advantages of an artificial urinary sphincter?

The main advantage of an artificial urinary sphincter is that it treats stress incontinence, allowing you to hold urine during daily activities and pee when you wish.

What are the problems with an artificial urinary sphincter?

All surgical procedures carry some risk, including:

• Anesthesia problems.
• Healing problems.
• Infection.
• Scarring.
• Bleeding.

Problems that are specific to AUS surgery may include:

• The parts of your AUS stop working or break down and a urologist needs to replace them.
• Worsening urge incontinence.
• Straining to pee.
• Damage to your urethra, bladder or nearby organs.
• Difficulty using the pump.
• The cuff gradually wears away tissue (device erosion).

How long does an artificial urinary sphincter last?

An artificial urinary sphincter can last for up to 10 years. Once it stops working, a urologist must replace it.

What is the success rate of the artificial urinary sphincter?

The artificial urinary sphincter has a high success rate. Some studies show a success rate of over 90%. However, you may develop incontinence again. The AUS may break down or your urethra may wear away (urethral erosion), requiring a new AUS or a different treatment option.

How soon after treatment will I feel better?

Your body, specifically the area of your urethra that the cuff covers, needs to heal before a healthcare provider activates your artificial urinary sphincter for use. This usually takes between six to eight weeks after the procedure.

Your incisions should heal within two weeks.

How can I take care of myself after this treatment?

Avoid strenuous activities and sexual activity — including masturbation— for at least four weeks after the artificial urinary sphincter procedure. Complications may occur if you don’t take the time to allow your incisions to fully heal, including:

• Ripping your stitches.
• Infection.
• Increased pain
• Bleeding.

You should also avoid taking a bath until you heal. Showering is OK, but it’s important to keep the area as dry and clean as possible to avoid infections.

When can I go back to work or school?

It’s a good idea to take between five and seven days off from work or school. If you have a more physically demanding job, you may need to take more time off.

When should I see my healthcare provider?

Schedule follow-up appointments with a healthcare provider after artificial urinary sphincter surgery. They’ll want to see how you’re healing after two weeks, and they’ll activate the AUS after six to eight weeks.

Contact a healthcare provider if you:

• Have discoloration and tenderness or a pus-like drainage from your incisions.
• Have bleeding from your incisions.
• Can’t pee for more than six hours.
• Have a fever greater than 101.5 degrees Fahrenheit (38.6 degrees Celsius).
• Have an increase in bruising in your penis or scrotum.

If you have any other questions about your AUS, call a provider.

What is the best artificial urinary sphincter?

There are many different brands of artificial urinary sphincters. Talk to a healthcare provider. They can help you decide which AUS is best for you.

A note from Cleveland Clinic

Incontinence can be an embarrassing problem for many, especially when it occurs during something as simple as coughing, sneezing or working out. If you’ve tried medications, pelvic floor exercises, bladder retraining or other treatments and you still have problems, talk to a healthcare provider about an artificial urinary sphincter. You shouldn’t have to be embarrassed or worry about leaks. An AUS can provide long-term relief of your incontinence symptoms.