Placement of an artificial urinary sphincter

What does this gesture consist of?

An artificial urinary sphincter (AUS) is an implantable device that replaces or supplements the function of the natural sphincter when it is impaired. It consists of three main parts: an inflatable cuff surrounding the urethra, a control pump (manual pump), and a reservoir balloon. When activated, the device compresses the urethra to prevent urinary leakage. To urinate, the patient activates the pump, which opens the urethra for the necessary time, and then the system closes automatically. This procedure is particularly indicated in cases of post-prostatectomy incontinence (urinary incontinence after prostate surgery), when stress urinary leakage is severe and persists despite well-conducted rehabilitation. It is considered the standard treatment in this situation.

In what cases?

Indications

When the implantation of an artificial urinary sphincter is proposed:

• Severe to major urinary incontinence after prostate surgery (radical prostatectomy), or after prostate interventions, if pelvic floor rehabilitation is not sufficient.
  
• Significant stress urinary incontinence, or heavy leakage (often > 300-500 mL/24h) depending on the case.
  
• Patient’s ability to manipulate the manual control pump (skill, dexterity, understanding) to trigger urination.
  
• Sterile urine, no urinary tract infection at the time of the procedure.
  
• Favorable skin condition, good healing expected, no major history that contraindicates the procedure (e.g., chronic infection, healing problems).
  

Operating technique & procedure

Here is how the implantation of an artificial sphincter typically proceeds: 1. Preparation before the operation

• Clinical assessment: urodynamics, flowmetry, post-void residual assessment, urethral examination (endoscopy) to rule out any obstruction.
  
• Urine analysis to ensure the absence of infection.
  
• Information and consent, explanation of the device, the procedures, the post-operative care.

2. Surgical intervention

• Anesthesia: general or regional depending on the patient.
  
• Incisions: often one in the perineum, one in the inguinal fold or in the abdominal region depending on the type of sphincter used. Sometimes via the scrotal route in men in certain cases.
  
• The cuff is placed around the urethra, and the reservoir balloon and pump are positioned. The components are connected, and the system is closed.
  
• The sphincter is left deactivated during the healing period (often several weeks) before being put into service.
  

3. Hospitalization and follow-up

• Hospitalization is usually short (a few days) for monitoring.
  
• Post-operative urinary catheterization, pain management, local care.
  
• Sphincter activation phase (commissioning) after healing, often around 4 to 6 weeks.
  

Expected results & effectiveness

• The rate of complete continence (no leakage) or social continence (very minimal leakage acceptable) is high: many series report perfect continence in ~ 75% of cases, with significant improvement in most of the others.
  
• Patient satisfaction is very good, especially after other solutions have failed (rehabilitation, slings, etc.).
• Device lifespan: although mechanical, the components may require overhauls or replacements over the years (pump, sleeve, leak, wear).