Artificial Urinary Sphincter

Overview

An artificial urinary sphincter (AUS) is a small, implantable device that helps control urine leakage. It works like a tiny, adjustable cuff that gently squeezes the tube that carries urine out of the bladder (the urethra). A small pump placed in the scrotum lets you open the cuff when you need to urinate, then close it again to prevent leaks. It is used for people with severe urinary incontinence (loss of bladder control) when other treatments have not worked well.

The artificial urinary sphincter is not a common first treatment. It is usually considered for severe leakage after simpler options have been tried. Many urologists (bladder and urinary specialists) offer it, but it is a specialised procedure.

Most people who get an AUS are men whose bladder control was damaged by prostate surgery or radiation. It can also be an option for people with nerve problems that affect the bladder, or after pelvic injury. It is rarely used in children, and only for very specific conditions.

Symptoms

Common symptoms

• Leaking urine without warning, especially when coughing, laughing, lifting, or changing position.
• Needing to urinate often or urgently.
• Waking at night to urinate.
• Using pads or protective products every day.
• Wetness that affects work, exercise, or social life.
• Skin irritation in the genital area from urine.

Symptoms in children

• Children rarely need an artificial urinary sphincter. When used, it is for children born with certain bladder or nerve conditions that cause severe leakage.
• Parents may notice constant wetness, repeated urinary infections, or skin problems.

Symptoms in older adults

• Older adults may have leakage along with other health issues.
• The specialist will check overall health, memory and thinking, and ability to use the pump before recommending surgery.
• An AUS can still be an option for some older adults who are healthy enough for surgery.

Causes

Main causes

• The main reason for needing an AUS is damage to the natural urinary sphincter (the ring of muscle that keeps urine in).
• Common causes include prostate surgery for cancer, radiation treatment to the pelvis, pelvic injury, and nerve conditions such as spina bifida or spinal cord injury.

Risk factors

• Being male and having had prostate surgery.
• Radiation to the pelvis.
• Neurological conditions that affect bladder control.
• Older age and weaker pelvic muscles.
• Obesity and long-term constipation, which can add pressure on the bladder.
• Smoking, which slows healing and raises surgery risk.

When to see a doctor

See a doctor urgently if:

• You have a fever, chills, or feel very unwell after surgery.
• You cannot pass urine and have severe pain.
• The wound is red, hot, swollen, or leaking pus.
• The device feels like it is poking through the skin, or the scrotum is very swollen.
• You have heavy bleeding.

Book a routine appointment if:

• Leakage continues or comes back after surgery.
• You need help learning to use the pump.
• You are planning travel or heavy activity and want advice.
• You have repeated urine infections.
• You are considering an AUS and want to discuss your options.

Diagnosis

An AUS is not diagnosed like an illness. It is recommended after a specialist assesses your bladder control. The doctor will ask about your leaking, examine you, and may use tests to see how your bladder and sphincter work. The goal is to confirm that a weak sphincter muscle is the main problem and that surgery is safe for you.

Tests that may be done

• Bladder diary (a record of drinks, leaks, and toilet visits).
• Pad test (weighing pads to measure leakage).
• Urodynamic tests (pressure tests using a small tube).
• Cystoscopy (looking inside the bladder with a thin camera).
• Ultrasound or X-ray scans.
• Blood tests and urine tests to check for infection and general health.

What to expect at your appointment

You will usually see a urologist (a doctor who specialises in urinary problems). The visit includes questions, a physical exam, and possibly tests. You may be asked to try simpler treatments first. The specialist will explain benefits, risks, and what recovery involves so you can decide together.

Treatment

Treatment for severe leakage usually starts with simpler steps. An AUS is an option when pads, pelvic floor training, lifestyle changes, and other treatments do not control leakage enough. It is inserted during surgery and works only when you use the pump.

Self-care at home

• Keep a bladder diary to spot patterns.
• Do pelvic floor muscle exercises if your specialist advises.
• Use absorbent products for comfort and skin protection.
• Keep skin clean and dry. Use a barrier cream if needed.
• Avoid heavy lifting and straining while recovering.
• Follow your surgeon's instructions about when to use the pump and when to avoid it.
• Attend follow-up appointments.

Medical treatments

Doctors may suggest bladder training, pelvic floor therapy, absorbent pads, a catheter to empty the bladder, or devices placed in the urethra. Some medicines can help bladder muscle overactivity or reduce urine production, but they are not right for everyone. Other procedures include bulking injections or a sling. Your specialist will discuss which options fit your type of leakage. No specific medicine or dose is right for everyone, so ask your healthcare provider what is safe for you.

When is surgery considered?

An AUS is considered when the sphincter muscle is very weak and other treatments have not worked. The surgery is done in hospital under general anaesthesia (being asleep) or spinal anaesthesia (numbing from the waist down). The surgeon places a cuff around the urethra, a small pump in the scrotum (or labia in women), and a pressure balloon in the belly. You will usually have a catheter for a short time. The device is often left switched off for a few weeks to heal before you start using it. Your surgeon will tell you exactly when and how to use it.

Living with this condition

After healing, you learn to squeeze the pump to open the cuff and let urine out. The cuff then refills and closes on its own. Most people can go about daily life, work, and travel. Always carry a medical alert card or tell healthcare staff that you have an AUS, because they need to know before putting in a catheter.

Lifestyle tips

• Avoid lifting heavy objects or straining for the first weeks after surgery.
• Check with your surgeon before cycling, contact sports, or intense exercise.
• Empty your bladder regularly rather than waiting too long.
• Treat constipation with fluids, fibre, and movement.
• Stop smoking to help healing.
• Keep follow-up appointments and learn the signs of device problems.

Diet and exercise

Drink enough water, but limit caffeine and alcohol if they make leakage worse. Eat fibre-rich foods to prevent constipation. Gentle walking helps recovery. Ask your specialist about safe pelvic floor exercises and when to return to stronger exercise.

Mental health and emotional wellbeing

Leakage can feel embarrassing and can affect confidence, relationships, and mood. An AUS helps many people feel more in control, but surgery and recovery can also be stressful. It is okay to ask for emotional support. Talking to your partner, a counsellor, or a support group can help. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service right away.

Prevention

You cannot always prevent the nerve or muscle damage that leads to severe leakage. But you can lower some risks: treat constipation, stay active, keep a healthy weight, stop smoking, and follow advice after prostate or pelvic surgery. If you already have an AUS, good follow-up and careful use help prevent problems.

Vaccines

No vaccine prevents urinary incontinence or protects an artificial urinary sphincter.

Screening programmes

There is no routine screening for needing an AUS. If you have ongoing leakage after prostate surgery, ask your doctor about a continence assessment.

Complications

If left untreated

• Ongoing leakage can cause skin irritation, sores, and urine infections.
• It can lead to avoiding social activities, work, or exercise.
• Some people feel low in mood or isolated.
• If the device is not working and urine cannot drain, this can be urgent. See the emergency signs above.
• Device problems can include infection, erosion (the cuff wearing into tissue), or mechanical failure.

Long-term outlook

Most people who have an AUS see a big drop in leakage and feel more confident. The device does not suit everyone, and it can need repair over time. Your care team will help you weigh the benefits and risks. With good follow-up, many people live active lives.

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