The artificial urinary sphincter is a surgically implanted device used to treat urinary incontinence when more conservative treatments have failed. It has three main parts - a cuff that wraps around the urethra and can be inflated to prevent leakage, a pump implanted in the scrotum or labia to control fluid transfer, and a balloon reservoir. The device is implanted through abdominal and perineal incisions and remains hidden inside the body. It can be manually activated after healing to help the patient regain urinary control. While generally effective, there are risks of infection, erosion or device failure that may require replacement surgery. It is an expensive option usually only considered when other approaches are deemed inappropriate.

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Artificial 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 manage
controlling urinary incontinence and urine continues to leak, the
which has been in use since 1972. urologist may decide that an AUS
is necessary. An AUS is fitted
Usually, when the bladder is full, either to strengthen a small part of
the urge to urinate is felt because the urethra, or to squeeze a small
a message goes from the brain, part of the bladder neck (bulbar
through the network of nerves in urethra). The device is made from
our back (spinal cord), to the natural silicone elastomer - a synthetic
sphincter (muscle that keeps the (non-latex) rubber so the body isn’t
urethra closed). When it receives likely to become sensitive to, or
the message, the sphincter relaxes reject the material. It has three main
and allows the bladder to empty. parts: a cuff, a pump and a balloon.
Afterwards, it tightens again, All three parts are connected by
squeezing the urethra (the opening silicone tubing.
which allows urine to leave the
body) 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 implanted
the brain to the natural sphincter. through an incision (cut) in the
This often happens because the lower abdomen. In males, an
nerve supply (communication additional incision is made just
network) is damaged, as in behind the scrotum on either the
spina bifida. The bladder is then left or right side. The AUS is hidden

2. Artificial Urinary Sphincter (AUS)
inside the body with the balloon switched “off” to allow the body to
in the abdomen and the pump in adjust to having the implant, and
either the left or right scrotal sac in to allow swelling to settle. Within
males, or the labia in females. The four to six weeks after surgery,
cuff, which holds a small amount the doctor or nurse specialist will
of water, is inflated and then gently activate or switch “on” the AUS
wrapped around the urethra. and explain how to use it.
How does it work? As with all surgery, very occasionally
things do go wrong. Sometimes
The inflated cuff applies gentle the cuff does not provide sufficient
pressure to the urethra, helps to pressure on the urethra to stop
hold the urine in the bladder, and urine from leaking out of the bladder
thereby improves continence. The and the cuff needs to be replaced
pump has a soft curved end which with one that gives a higher
can easily (and gently) be pressed pressure range. Infection, pump
to shift the water from the cuff to the failure and erosion may also occur
balloon. 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, but
the sphincter so the urine is free to this can be overcome by changing
be drained. The bladder can then the position of the cuff.
be emptied by whatever means is
normally used, for example clean Who is it for?
intermittent catheterization (CIC
- see leaflet). After a few minutes Although the artificial urinary
the fluid returns to the cuff, and the sphincter is a very effective way
pump returns to its original shape. of maintaining continence when
The bladder once again becomes the sphincter is weak, it is used
continent. only when other methods fail or
the urologist decides they are
When can it be used? inappropriate.
For the first month after surgery, Insertion of an artificial sphincter
the AUS is left deactivated, or is an expensive operation, but if

3. the cost of providing incontinence
pads and protective bed pads, etc
for a lifetime are taken into account,
then this alternative method proves
to be more cost effective in the long
run.
Candidates for this type of surgery
need to be carefully selected though
because four-hourly emptying of the
bladder is essential. Furthermore,
the AUS is generally not advisable
for boys before puberty, due to
physical changes.

4. Help us
Shine relies on people’s generosity and support so we can help our clients
who depend on us for help and advice - people with hydrocephalus, spina
bifida, their families and carers. To donate to Shine please visit
www.shinecharity.org.uk or call 01733 421329.
This information has been produced by Shine’s medical advisers and
approved by Shine’s Medical Advisory Committee of senior medical
professionals.
Shine - Registered charity no.249338
To see our full range of information sheets and to find out how to donate to
Shine please visit www.shinecharity.org.uk