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BackTable / Urology / Topic / Procedure
Artifical Urinary Sphincter (AUS) Surgery
The goal of Artificial Urinary Sphincter (AUS) Surgery is to prevent urine from leaking out of the bladder. When the urinary sphincter muscle loses control of its contractions, an artificial urinary sphincter can be inserted to control the flow of urine out of the bladder. The AUS consists of a balloon, pump, and urethral cuff; these three components work together to mimic a natural urinary sphincter and give the patient control over urination.
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Artificial Urethral Sphincter Surgery Approach
Using the perineal approach in an AUS surgery allows full access to the urethra and is useful for both single and double cuff placement. The balloon is placed deep in the transversalis fascia via a midline or inguinal approach, and the pump is placed on the same side as the patient’s dominant hand, for better accessibility. As the patient squeezes the pump that is placed in the scrotum, the fluid inside the cuff is moved to the pressure-regulated balloon. The cuff is wrapped around the urethra and deflates, allowing the urethra to open for urination. Fluid flows back from the balloon to the inflate cuff and closes the urethra. Once the physician activates the cuff about six weeks after the surgery, the patient can begin using the AUS.
Artifical Urinary Sphincter (AUS) Surgery Podcasts
Listen to leading physicians discuss artifical urinary sphincter (aus) surgery on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Episode #11
Dr. Aditya Bagrodia interviews urologist Dr. Steve Hudak from UT Southwestern Medical Center about post-prostatectomy incontinence. They cover an array of topics including, incontinence evaluation, managing patient expectations, kegel exercises and pelvic floor therapy, and slings vs. artificial urinary sphincters.
Artificial Urethral Sphincter Surgery Indications
AUS surgery is most commonly performed in men with significant incontinence. Prostate removal or radiation therapy for prostate cancer are two of the main causes for significant incontinence in males. The AUS device replicates the functions of the patient’s biological urinary sphincter. Inserting an artificial urinary sphincter allows patients to prevent leakage of urine and control the flow of urine from the bladder. AUS failure is more common in patients with recurrent urinary tract infections, prior urethral surgery, or neurogenic bladder dysfunction.
References
[1] About your artificial urinary sphincter. Memorial Sloan Kettering Cancer Center. (2019, October 18). https://www.mskcc.org/cancer-care/patient-education/artificial-urinary-sphincter
[2] Urology Artificial Urinary Sphincter (AUS) Surgery. VHC Physician Group. (n.d.). https://www.vhcphysiciangroup.com/urology/services/procedures/outpatient-surgery/artificial-urinary-sphincter-insertion/
[3] Brant, W. O., & Martins, F. E. (2017, August). Artificial urinary sphincter. Translational andrology and urology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583059/
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