Artificial urinary sphincter

A device for bladder incontinence

The artificial urinary sphincter has been available since 1973 for men who experience prolonged bladder incontinence following treatment for prostate cancer. 

This device typically consists of a cuff, a pump, and a balloon.  It is surgically implanted.

How it works:

  1. The cuff is filled with a saline fluid
  2. It compresses the urethra to keep it closed, which prevents urine from leaking

When a man is ready to urinate, he squeezes the pump, which is implanted into his scrotum. This:

  1. Pulls the fluid from the cuff into the balloon
  2. Releases the compression on the urethra
  3. Allows the urethra to open so an man can urinate

In some ways, it is similar to the way a blood pressure cuff works, except this cuff automatically refills with the saline fluid several minutes after it is deflated.

Results are mixed

While clinical studies have reported ten-year success rates with the device, many men have had to undergo additional surgery because the device:

  • Failed to work properly
  • Eroded
  • Or caused infection

In one study (Fulford et al) of 61 men, after 10 years, 49 men needed at least one further surgery to correct a problem. In another study of 70 men (Clemens et al), about half needed additional surgery five years after receiving their artificial urinary sphincter.

In a third study of 113 men (Montague et al), a large majority of men (60%) were “socially continent” about six years after getting an artificial urinary sphincter, which means they used up to 1 pad a day. It was also reported that:

  • 4% of men were completely continent
  • 31% of men needed to use 2 to 3 pads a day

Of all the men in this same study, here's what they had to say about their satisfaction with the device:

  • 28% were “very satisfied”
  • 45% were “satisfied”
  • 18% were “neutral”
  • 6% were “dissatisfied”
  • 4% were “very dissatisfied”

Artificial urinary sphincter: not for everyone

This surgical approach is generally considered when other therapies (including the male sling procedure) have failed.

Like any surgery, it carries risks and potential complications, including:

  • Heart attack
  • Stroke
  • Blood clots
  • Infection

It also requires good manual dexterity, as the man must operate the scrotal pump to urinate. Before deciding on this approach, ask your doctor about all the benefits and associated risks.

Back to coping with incontinence


Medications
Collagen injections
Sling procedure

References:

Atiemo HO, Moy L, Vasavada S, Rackley R. Evaluating and managing urinary incontinence after prostatectomy: beyond pads and diapers. Cleveland Clinical Journal of Medicine. 2007;74 (1):57-63.

Clemens JQ, Schuster TG, Konnak JW, McGuire EJ, Faerber GJ. Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol. 2001;166:1372-1375.

Fulford SC, Sutton C, Bates G, Hickling M, Stephenson TP. The fate of the ‘modern’ artificial sphincter with a follow-up of more than 10 years. Br J Urol. 1997;79:713-716.

Montague DK, Angermeier KW, Paolone DR. Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. J Urol. 2001;166:547-549.

Always consult a medical professional.

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