Artificial Urinary Sphincter (AUS)

What is an artificial urinary sphincter?

The AUS is a three-part implanted device: a soft cuff placed around the urethra, a pressure-regulating balloon in the lower abdomen, and a small control pump placed in the scrotum. The cuff normally keeps the urethra closed. When you want to urinate, you squeeze the pump a few times, the cuff opens for a couple of minutes, and then it refills on its own.

Who may benefit from an AUS?

• Men with moderate to severe leakage after radical prostatectomy.
• Men with leakage after radiation, TURP, or HoLEP that has not improved with therapy.
• Men whose sling has failed or who leak too much for a sling to work well.
• Men with the hand strength and cognitive ability to operate the pump.

How is the procedure performed?

Through a small perineal incision and a lower abdominal incision, the cuff is placed around the urethra, the balloon is positioned behind the pubic bone, and the pump is placed in the scrotum. The operation usually takes one to two hours and is often same-day or one overnight stay.

What are the benefits?

• The most reliable long-term treatment for significant male stress incontinence.
• Most men go from multiple pads a day to no pads or one security pad.
• Works for leakage of many different severities, including after radiation.

What are the alternatives?

Pelvic floor physical therapy, lifestyle and fluid management, a penile clamp (such as a Cunningham clamp) or absorbent products, urethral bulking, and a male sling. A sling is generally best for mild to moderate leakage without prior radiation; the AUS is preferred for heavier leakage.

What are the risks?

• Infection of the device, which may require removal.
• Erosion of the cuff through the urethra, more likely after radiation.
• Mechanical failure over time; most devices eventually need revision.
• Persistent or recurrent leakage requiring adjustment.
• Difficulty urinating or scrotal discomfort in the early weeks.

What should I expect before surgery?

• A pre-operative visit to review your history, medications, and goals.
• Instructions on blood thinners, supplements, and diabetes medications.
• A urine culture so any infection is treated before the procedure.
• Nothing to eat or drink after midnight unless told otherwise.
• A responsible adult to drive you home on the day of surgery.

What happens on the day of surgery?

You are given antibiotics before the incision, the surgery is performed under general anesthesia, and you go home the same day or the next morning with the device deactivated.

Will I have a catheter?

A catheter is usually placed during surgery and removed before you go home or the next morning.

What should I expect during recovery?

• The device stays deactivated for about six weeks so tissues can heal, so you will keep leaking during that time.
• Scrotal swelling and bruising are expected and settle over two to three weeks.
• No heavy lifting, cycling, or straddling activity for six weeks.
• Once the swelling settles, gently pull the pump down in the scrotum once a day so it stays in a good, easy-to-reach position.
• At the activation visit you are taught to use the pump.

When can I return to work and exercise?

Desk work in one to two weeks. Full activity and exercise after activation at around six weeks.

When should I call the office?

• Fever above 101.5°F or shaking chills.
• Inability to urinate, or a catheter that stops draining.
• Heavy bleeding, or clots that do not clear with increased fluids.
• Pain that is not controlled by your prescribed medication.
• Redness, swelling, or drainage at an incision site.