shinecharity.org.uk email@example.com 42 Park Road Peterborough PE1 2UQ 01733 555988Artificial Urinary Sphincter (AUS)What is it? considered to be “neuropathic” and must be managed.The artificial urinary sphincter (AUS)is a surgically implanted device for If the bladder is difficult to managecontrolling urinary incontinence and urine continues to leak, thewhich has been in use since 1972. urologist may decide that an AUS is necessary. An AUS is fittedUsually, when the bladder is full, either to strengthen a small part ofthe urge to urinate is felt because the urethra, or to squeeze a smalla message goes from the brain, part of the bladder neck (bulbarthrough the network of nerves in urethra). The device is made fromour back (spinal cord), to the natural silicone elastomer - a syntheticsphincter (muscle that keeps the (non-latex) rubber so the body isn’turethra closed). When it receives likely to become sensitive to, orthe message, the sphincter relaxes reject the material. It has three mainand allows the bladder to empty. parts: a cuff, a pump and a balloon.Afterwards, it tightens again, All three parts are connected bysqueezing the urethra (the opening silicone tubing.which allows urine to leave thebody) to keep urine from leaking How is it fitted?out of the bladder. Sometimes the“messages” aren’t able to get from The AUS is surgically implantedthe brain to the natural sphincter. through an incision (cut) in theThis often happens because the lower abdomen. In males, annerve supply (communication additional incision is made justnetwork) is damaged, as in behind the scrotum on either thespina bifida. The bladder is then left or right side. The AUS is hidden
Artificial Urinary Sphincter (AUS)inside the body with the balloon switched “off” to allow the body toin the abdomen and the pump in adjust to having the implant, andeither the left or right scrotal sac in to allow swelling to settle. Withinmales, or the labia in females. The four to six weeks after surgery,cuff, which holds a small amount the doctor or nurse specialist willof water, is inflated and then gently activate or switch “on” the AUSwrapped around the urethra. and explain how to use it.How does it work? As with all surgery, very occasionally things do go wrong. SometimesThe inflated cuff applies gentle the cuff does not provide sufficientpressure to the urethra, helps to pressure on the urethra to stophold the urine in the bladder, and urine from leaking out of the bladderthereby improves continence. The and the cuff needs to be replacedpump has a soft curved end which with one that gives a highercan easily (and gently) be pressed pressure range. Infection, pumpto shift the water from the cuff to the failure and erosion may also occurballoon. When it is time to urinate in some people, in which case, the(wee), the pump is pressed, and system would have to be replaced.the pressure is released, relaxing Ejaculation may be a problem, butthe sphincter so the urine is free to this can be overcome by changingbe drained. The bladder can then the position of the cuff.be emptied by whatever means isnormally used, for example clean Who is it for?intermittent catheterization (CIC- see leaflet). After a few minutes Although the artificial urinarythe fluid returns to the cuff, and the sphincter is a very effective waypump returns to its original shape. of maintaining continence whenThe bladder once again becomes the sphincter is weak, it is usedcontinent. only when other methods fail or the urologist decides they areWhen can it be used? inappropriate.For the first month after surgery, Insertion of an artificial sphincterthe AUS is left deactivated, or is an expensive operation, but if
the cost of providing incontinencepads and protective bed pads, etcfor a lifetime are taken into account,then this alternative method provesto be more cost effective in the longrun.Candidates for this type of surgeryneed to be carefully selected thoughbecause four-hourly emptying of thebladder is essential. Furthermore,the AUS is generally not advisablefor boys before puberty, due tophysical changes.
Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus, spinabifida, their families and carers. To donate to Shine please visitwww.shinecharity.org.uk or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donate toShine please visit www.shinecharity.org.uk