Artificial urinary sphincter (AUS) surgery

An artificial urinary sphincter is considered the gold standard for treating men with urinary incontinence, but it is usually only considered when other, less invasive methods haven’t worked. Some alternatives to AUS include:

Pelvic floor exercises

Special exercises to strengthen the muscles in your pelvic floor.

Fluid management

This is a method of timing fluid intake and drinking smaller amounts throughout the day.

Bladder training

Gradually delaying passing urine by five to ten minutes each time you need to use the bathroom.

Lifestyle changes

These might include losing weight, stopping smoking, and avoiding caffeine and alcohol.

Medications

Certain medications can help to relax the bladder muscles or help the bladder to fully empty.

Bulking agents

Synthetic material is injected into the tissue around the urethra to help it close more effectively.

Catheters

Where a tube is placed into the bladder to drain urine out into a bag.

Incontinence pads

These do not stop incontinence, but are placed in the underwear to absorb urine leakage.

Male sling surgery

An operation in which a supportive pouch is created around the neck of the bladder to prevent stress incontinence (leakage of urine when coughing, sneezing, or laughing).

At your first consultation, you will be seen by a consultant urologist, a doctor specialising in conditions affecting the urinary system.

Your consultant will ask you about your symptoms, general health, and medical history. They may order tests to check your bladder and lower urinary tract such as a cystoscopy and urine flow tests.

At the end of your appointment, your consultant will decide if AUS is suitable for you based on your symptoms, general health, and the results of any tests or scans. They will explain the procedure to you including what happens during AUS surgery, any possible risks and complications, and what to expect afterwards.

Your first consultation is important because it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your procedure, so please discuss any questions or concerns with your consultant at your appointment.

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

You may need to have a urine test before your operation to make sure you don't have a urinary tract infection (UTI). If you have a UTI, your surgery may need to be postponed until the infection is treated.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

AUS surgery is normally performed under general anaesthetic, meaning you'll be asleep for the procedure.

During AUS surgery, once the anaesthetic has taken effect, your consultant will make two incisions. One is in your perineum (the space between your scrotum and your anus) and one is in your lower abdomen.

The artificial urinary sphincter device is put in place and the incisions are closed with dissolvable sutures.

After your surgery, you will be taken to the recovery room where your blood pressure, heart rate and breathing will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery.

Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

When you wake up, you will have a tube called a urinary catheter in your bladder to drain urine. This is normally removed before you are discharged from hospital. You will normally spend one night in hospital after AUS surgery.

You may have some pain and swelling for the first two to three weeks after your operation. Your consultant will prescribe medication to manage this.

You will not be able to drive yourself home from hospital after your surgery. This is due to the general anaesthetic which can impair your concentration and reaction times for up to forty-eight hours. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on your individual recovery and the type of job you do. If your job is sedentary, you may feel ready to return to work within a few days. Avoid strenuous activity, heavy lifting, or straining for six weeks after your AUS surgery.

How soon can I drive?

You must not drive for forty-eight hours after a general anaesthetic. After this, you can drive when you can sit comfortably for prolonged periods and perform an emergency stop.

When will I be back to normal?

Recovery from surgery is a gradual process that is different for everyone. Go at your own pace during your recovery and build up your activity level gradually. Stop if you feel tired or have any pain. Follow your consultant's instructions carefully and call the hospital if you have any questions or concerns.

• When you are discharged your AUS will be deactivated. You will need to return to the hospital after six weeks for your consultant to activate the device
• You will be given a scrotal support to wear for the first week after your surgery
• You can shower 48 hours after your AUS surgery. If you have any dressings, you can remove them before your shower and leave them off. Wash the area gently with mild soap and pat dry with a clean towel. Keep your incisions clean and dry and don't apply any creams, lotions, or ointments to the area
• Do not have sexual intercourse until your consultant tells you it's safe to do so. This is normally after your AUS has been activated, around six weeks after your surgery

Most people can resume normal daily activities by four to six weeks after AUS surgery.

Like all surgical procedures, artificial urinary sphincter surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to artificial urinary sphincter surgery include:

• Infection that may require the AUS to be removed
• Problems with any part of the AUS meaning it may need to be removed and replaced
• Injury to the urethra
• Problems urinating
• Continued urinary incontinence

Contact your healthcare provider if you experience:

• Fever (temperature over 38C)
• Severe pain, or pain that doesn't improve with medication
• Bleeding
• Increased swelling
• Difficulty urinating
• Bladder spasms

We answer some of your most commonly asked questions about artificial urinary sphincter.

How long does an artificial urinary sphincter last?

An AUS normally lasts around eight to ten years but may last as long as 20 years. After this, your AUS will need to be replaced.

How do you deactivate an artificial urinary sphincter?

To deactivate your AUS, squeeze the pump to divert fluid from the cuff to the balloon. Your consultant will show you how to do this. The cuff will reinflate itself after two to five minutes.

What is the success rate for an artificial urinary sphincter?

AUS is currently the most effective treatment for male urinary incontinence. One study concluded a 91.8% success rate after two years.

How painful is artificial urinary sphincter surgery?

You may experience some mild to moderate post-operative pain after your surgery. This can usually be managed with over-the-counter painkillers like paracetamol, and normally resolves within two to three weeks. Contact your consultant if you experience significant or worsening pain after your AUS.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or find out more about artificial urinary sphincter surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Artificial urinary sphincter: Innovations and Practices, Mayo Clinic
2. Artificial urinary sphincter, Medline Plus
3. Artificial urinary sphincter: Current status and future directions, PubMed
4. Artificial urinary sphincter in men, Cambridge University Hospitals NHS Foundation Trust