Artificial Urethral Sphincter (AUS)

Urology

What is Stress Urinary Incontinence?

Stress urinary incontinence is the leakage of urine with exercise or exertion that increases intraabdominal pressure, e.g. coughing, sneezing, laughing. It may occur in men after a radical prostatectomy (surgery for removal of the prostate) or radiation therapy to the prostate. It can also occur after trauma to the pelvic floor muscles.

Who is suitable for Artificial Urinary Sphincter (AUS)?

An AUS is a small device that is placed inside your body to help control significant urinary leakage due to stress urinary incontinence.

What is an AUS?

An AUS is a device that simulates your natural urinary sphincter for urinary control. It is completely concealed with no external parts, so urinary control is discreet. It is placed through a surgery. It consists of three parts:

1. Urethral cuff: This wraps around your urethra to control urinary flow. In the resting state, the cuff is filled with fluid, which closes the urethra and keeps you continent. When the cuff is

emptied, the urethra is now open, allowing urine to flow through.

2. Pump: This is placed in your scrotum and is required for control of the AUS by regulating the amount of fluid within the cuff.

3. Reservoir (Pressure-regulating balloon): This is a small balloon filled with fluid placed under your abdominal muscles. It is a reservoir that stores the fluid used in the AUS.

Figure 1.

Drawing of a male artificial sphincter to control urination

Source: The Simon Foundation for Continence

At rest, the cuff remains closed and urinary continence is maintained. To pass urine, the pump in the scrotum is gently squeezed, which deflates the cuff and opens the urethra. The cuff closes automatically in several minutes after your bladder is emptied.

How is the surgery to place an AUS performed?

The surgery is performed under General Anaesthesia. Two small incisions are made at the perineum (the area between the scrotum and anus) and the abdomen. After placement of the AUS, the incisions will be closed with absorbable sutures.

What tests may be done prior to the surgery?

• Urodynamic study to evaluate your urinary tract function

• 24-hour pad test to identify the number of pads utilised and amount of urine leaked

• Cystoscopy to evaluate your bladder

• Pre-operative investigations (blood tests, ECG, chest x-ray) depending on your Anaesthetist’s assessment

Are there any risks involved? Complications are not commonly seen but the procedure carries risks of:

• Swelling and bruising at the wound site

• Bleeding

• Infection, which may require removal of the AUS

• Malfunctioning of the AUS, which may require surgery for revision

• New onset of urge incontinence

• Injury to the urethra

• Urethral erosion

• The AUS may wear out after 5 to 10 years of usage and will require a replacement

What are the alternatives?

• Continence aids e.g. pads; penile clamps to reduce urinary leakage

• Pelvic floor exercises to strengthen pelvic floor and reduce urinary leakage

• Insertion of a male sling –a mesh sling to support the urethra to restore normal bladder control; usually for patients with less severe urinary incontinence

• Long-term urinary catheter –urethral or suprapubic catheter

• Urinary diversion which involves surgery to divert urine from the ureters to a length of bowel which is brought to the abdomen as a stoma

Preparation for the surgery

You may be instructed as below:

• Do not take any blood thinning medications, such as Aspirin, one week prior to the procedure

• Please inform your Urologist regarding any blood-thinning or anti-clotting medications you may have

What do I have to expect after surgery?

• You may resume your regular diet after the procedure

• All patients will have a urinary catheter post-operatively for a short period of time

• You will be given a course of oral antibiotics to complete upon hospital discharge

• As the AUS will remain deactivated until the wounds are healed, you will continue to experience urinary leakage after the procedure until the AUS is activated

• Activation of the AUS typically takes place about six to eight weeks after the surgery. You are advised to keep the wounds clean and dry after the surgery

• Should urinary catheterisation be required later on after the surgery, always consult a Urologist due to risk of damage to the AUS

When should I seek medical attention after the surgery? Please seek medical attention if you experience:

• Wound infection (fever, redness, swelling)

• Intolerable pain at the operative site

Contact Information

Please contact our Customer Contact Centre at 6555 8828 for an urgent appointment to return to the Urology Clinic during Office Hours.

For any emergency after office hours, please proceed to the KTPH Acute and Emergency Department (A&E).

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg

Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg

Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg