MALE CONTINENCE & RECONSTRUCTIVE UROLOGY • BRISBANE
Artificial Urinary Sphincter
Educational information about artificial urinary sphincter surgery for male stress urinary incontinence, including assessment, device function, recovery, risks and the possibility of future revision.
An artificial urinary sphincter is an implanted continence device used in selected men with stress urinary leakage caused by weakness of the urinary sphincter. It is most commonly discussed after prostate treatment, but it can also have a role in selected neurological and reconstructive situations.
Educational information only. This page does not recommend a particular device, manufacturer or operation and does not predict an individual continence outcome.
UNDERSTANDING THE INDICATION
What type of urinary leakage is an artificial sphincter designed to treat?
The artificial urinary sphincter is primarily used for male stress urinary incontinence: leakage that occurs when the urinary sphincter cannot maintain closure during coughing, standing, lifting, exercise or other increases in abdominal pressure.
This can occur after prostate cancer surgery, other prostate treatment, pelvic procedures, urethral reconstruction or neurological disease. The operation is not intended to treat every cause of urinary leakage.
Urgency leakage, poor bladder emptying, overflow incontinence and high-pressure neurogenic bladder may require different or additional management. Mixed symptoms therefore need to be understood before continence surgery is planned.
CLINICAL SITUATIONS
When might artificial urinary sphincter surgery be discussed?
Suitability depends on the cause and severity of leakage, previous treatment, urethral health, bladder function and the person's ability to operate the device.
After prostate cancer surgery
Persistent stress urinary leakage after prostate removal is a common reason for specialist continence assessment when recovery and conservative treatment have plateaued.
After other prostate treatment
Incontinence can also follow other prostate procedures. Previous radiation treatment is particularly relevant because it can alter tissue quality and complication risk.
After urethral reconstruction
Selected men with sphincter weakness after urethral or pelvic reconstruction may be considered, but previous stricture surgery can change cuff location and erosion risk.
Neurological stress incontinence
An artificial sphincter can be considered in selected men with neurogenic sphincter weakness, provided bladder storage pressure, emptying and long-term catheter needs are understood.
Persistent leakage after previous continence surgery
Previous sling or sphincter surgery does not automatically exclude further treatment, but the anatomy and reason for prior treatment failure need reassessment.
Complex or mixed incontinence
When stress leakage coexists with urgency, retention, stricture or neurological bladder dysfunction, the treatment sequence needs to be individualised.
BEFORE IMPLANT SURGERY
How male stress urinary incontinence is assessed
The assessment aims to confirm the leakage mechanism, understand bladder function, identify urethral risk factors and determine whether an implanted continence device is one of the reasonable options.
Continence history
The pattern and severity of leakage, pad use, activity-related leakage, urgency, night-time symptoms, previous continence treatment and the effect on daily life are reviewed.
Bladder emptying
Flow and residual urine assessment may be used to determine whether bladder emptying is adequate and whether obstruction or impaired contraction may also be present.
Urethral assessment
Previous stricture, urethroplasty, radiation, traumatic catheterisation, erosion or bladder-neck narrowing can materially affect operative planning and device risk.
Endoscopic assessment when indicated
Cystoscopy may be used to assess the urethra, sphincter region, bladder neck and lower urinary tract, particularly when prior surgery or narrowing is relevant.
Bladder function
Urodynamics may be useful when urgency is significant, emptying is abnormal, neurological disease is present or there is concern about bladder compliance or pressure.
Ability to operate the device
The person needs sufficient hand function, understanding and access to the scrotal pump to operate the system reliably in everyday life.
GENERIC DEVICE EDUCATION
How does an artificial urinary sphincter work?
The device is implanted completely inside the body. Although exact design can vary, a commonly used concept includes a cuff around the urethra, a control pump placed in the scrotum and a pressure-regulating fluid component positioned elsewhere beneath the skin.
Urethral cuff
The cuff sits around a selected segment of urethra and provides outlet resistance during bladder filling.
Scrotal control pump
The pump is operated manually when the person wants to pass urine.
Fluid-regulating component
A connected component allows fluid to move within the closed system as the cuff is opened and later refills.
Between voids
The cuff applies controlled pressure around the urethra to reduce stress leakage.
To pass urine
The scrotal pump is operated to temporarily reduce cuff pressure and open the urethral outlet.
After voiding
The system returns toward its resting configuration over time without repeated pump activation.
This description is intentionally generic and is not a product manual or instruction for operating any specific implanted device.
SHARED DECISION-MAKING
What alternatives may be discussed?
An artificial sphincter is not the only management option for male urinary leakage. The alternatives depend on leakage severity, cause, previous treatment, radiation, urethral history and personal priorities.
Pelvic-floor rehabilitation
Pelvic-floor therapy can form part of recovery and conservative management, particularly after prostate surgery.
Continence products & collection strategies
Pads, external collection systems and other practical strategies may remain reasonable options depending on symptom burden and preference.
Male sling surgery
A sling may be discussed in selected men with stress incontinence. Suitability differs from artificial sphincter surgery and depends on individual factors.
Other reconstructive pathways
Complex urethral, bladder or neurological problems may require treatment of the underlying anatomy or bladder dysfunction before continence surgery.
SURGICAL PATHWAY
What does implantation involve?
The operation is performed under anaesthesia. The exact surgical approach depends on the anatomy, previous treatment and whether this is a first implant or revision procedure.
Preoperative planning
Previous prostate treatment, radiation, urethral surgery, continence procedures and urinary infections are reviewed. The lower urinary tract is assessed as required before implantation.
Implantation
The cuff, pump and connected fluid components are positioned beneath the skin through one or more surgical incisions. The configuration is selected according to the individual anatomy.
Early recovery
Swelling, bruising and discomfort occur to varying degrees. Urinary drainage may be needed for a period depending on the operation and early bladder emptying.
Healing before use
The device is generally left inactive during early wound healing. The timing of activation is individual and follows surgical review rather than a fixed website timetable.
Activation & teaching
Once healing is satisfactory, the device can be activated and the patient is taught how to operate the pump and when to seek help.
LIVING WITH THE DEVICE
Activation and everyday use
The device is not usually used immediately after implantation. A healing period allows swelling and operative tissues to settle before activation is considered.
At activation, the pump is located and the operating sequence is taught. The patient needs to be able to find and manipulate the pump reliably before independent use.
If future urethral catheterisation or instrumentation is required, healthcare professionals should be told that an artificial urinary sphincter is present. Device status may need to be considered before urethral instrumentation.
BALANCED DEVICE INFORMATION
Risks and limitations of artificial urinary sphincter surgery
An artificial urinary sphincter is an implanted mechanical device. Complications can occur at the initial operation or later and may require further surgery, revision or complete device removal.
Infection
Infection involving an implanted device can require treatment and may necessitate removal of some or all components.
Urethral erosion
The cuff can erode into the urethra. This is a significant complication and generally requires device removal and urethral management.
Mechanical malfunction
Device components can malfunction over time. A malfunctioning system may require revision or replacement.
Recurrent or persistent leakage
Continence may remain incomplete or worsen again over time. A dry outcome cannot be guaranteed.
Urinary retention or emptying difficulty
Difficulty voiding can occur, particularly if bladder contraction is weak or another outlet problem is present.
Urethral or tissue change
Tissue around the cuff can change over time and recurrent leakage may require reassessment of the urethra and device.
Pain, bleeding & wound problems
As with other surgery, pain, bleeding, bruising, wound complications and delayed healing can occur.
Pump or component positioning problems
A component may be difficult to access, migrate, rotate or cause local discomfort and occasionally require revision.
Future revision or removal
An implanted continence device should not be considered a lifetime guarantee. Revision or removal can become necessary.
This is not an exhaustive list. Risk varies with previous radiation, urethral surgery, prior erosion or infection, neurological disease, general health and the complexity of the reconstruction.
WHEN PLANNING IS MORE COMPLEX
Previous radiation, urethral surgery and a “high-risk urethra”
Some men have a higher risk of device complications because the urethra has been affected by previous radiation, reconstructive surgery, stricture disease, prior erosion or repeated instrumentation.
Previous pelvic radiation
Radiation can alter tissue blood supply and healing and is relevant when discussing erosion, infection and revision risk.
Urethral stricture or urethroplasty
A reconstructed or narrowed urethra may require additional assessment and can affect where and whether a cuff should be placed.
Previous sphincter erosion
Reimplantation after erosion requires reassessment of urethral healing and tissue quality and may involve a different reconstructive strategy.
Repeated continence surgery
Revision surgery can be more complex because of scar tissue, altered anatomy and previous component placement.
NEURO-UROLOGY
Artificial urinary sphincter surgery in neurological patients
An artificial urinary sphincter may be considered in selected men with neurogenic stress urinary incontinence. The decision is more than an outlet decision because the bladder itself may have abnormal pressure, compliance or emptying.
Increasing outlet resistance in a bladder that stores urine at unsafe pressure can create or worsen urinary-tract risk. Urodynamic assessment is therefore particularly important when neurogenic bladder is part of the picture.
Hand function, catheterisation requirements, sensation, cognition and the long-term neurological trajectory also affect whether a manually operated implant is practical.
Read the Neurogenic Bladder guide →LONG-TERM DEVICE CARE
What if the sphincter stops working or leakage returns?
Recurrent leakage does not have one cause. The device, urethra, bladder and operating technique may all need review.
Confirm the leakage pattern
New urgency leakage can be mistaken for device failure, while stress leakage may indicate a different mechanical or urethral issue.
Check device operation
Pump function and cycling can be assessed clinically, with further investigation selected according to the suspected problem.
Assess the urethra
Cystoscopy may be needed when erosion, stricture, tissue change or another urethral problem is suspected.
Consider revision individually
Revision can involve one or more components or a different surgical strategy depending on the reason for failure and tissue quality.
IMPORTANT EXPECTATION
Revision is part of the lifetime conversation
Because the system is a mechanical implant placed around living tissue, patients should understand before first implantation that later revision or removal may become necessary.
PREPARING FOR CONTINENCE REVIEW
What information is useful?
Previous prostate, radiation, urethral and continence treatment records can be particularly helpful when planning implant surgery or revision.
Details of previous prostate surgery or treatment
Radiation treatment history if applicable
Previous urethral stricture or urethroplasty records
Previous continence surgery or implant reports
Approximate pad use and when leakage occurs
Information about urgency, frequency or bladder emptying
Previous urodynamics or cystoscopy reports if available
A current medication list and relevant medical history
INTERSTATE & INTERNATIONAL PATIENTS
Seeking a continence or revision opinion from outside Brisbane?
Patients with complex post-prostatectomy incontinence, previous radiation, urethral reconstruction or an existing continence implant can provide prior operative reports, cystoscopy findings and other relevant records for review. The likely need for further assessment can then be discussed before major travel arrangements are made.
ARTIFICIAL URINARY SPHINCTER FAQ
Common questions
What is an artificial urinary sphincter?
It is an implanted continence device used in selected people with urinary leakage caused by weakness of the urinary sphincter. A manually operated pump temporarily opens the urethral cuff when the person wants to pass urine.
Who is usually considered for artificial sphincter surgery?
It may be discussed in men with persistent stress urinary incontinence after prostate or pelvic treatment, as well as selected reconstructive and neurological situations. Suitability depends on bladder function, urethral health, previous treatment and the ability to operate the device.
Will an artificial sphincter make me completely dry?
A completely dry result cannot be guaranteed. Continence outcomes vary, and some people continue to have some leakage or may later develop recurrent leakage requiring reassessment.
Does the device work automatically?
The urethral cuff maintains outlet resistance between voids, but the patient manually operates the scrotal pump when they want to pass urine. The system then returns toward its resting state.
Why does hand function matter?
The pump needs to be located and operated manually. Reduced dexterity, weakness, sensation or cognition can make independent use difficult and should be considered before surgery.
Can I have an artificial urinary sphincter after radiation treatment?
Previous radiation does not automatically exclude surgery, but radiation can affect tissue quality and is relevant to the risk of erosion, infection and later revision. Individual assessment is important.
Can I have one after urethral stricture surgery?
Selected patients can be assessed after urethral reconstruction, but previous stricture and urethroplasty can change tissue risk and cuff-planning considerations. The urethra should be assessed before implantation.
How soon after surgery is the device activated?
The device is generally left inactive during early healing. Activation timing depends on wound healing, swelling and the individual operation rather than a fixed timetable from a website.
Can the artificial sphincter wear out or fail?
It is a mechanical implant and malfunction can occur over time. Recurrent leakage or difficulty operating the device requires assessment and may lead to revision or replacement.
What is urethral erosion?
Erosion occurs when the cuff damages and enters the urethral wall. It is a significant complication and usually requires removal of the affected device components and management of the urethra.
What happens if I need a urinary catheter in the future?
Healthcare professionals should be told that an artificial urinary sphincter is present before urethral catheterisation or instrumentation. The device and urethra need to be managed appropriately to reduce injury risk.
Is an artificial sphincter appropriate for neurogenic incontinence?
It can be considered in selected men with neurogenic stress urinary incontinence. Bladder pressure, compliance, emptying, catheterisation needs, hand function and the neurological condition all need to be considered before increasing outlet resistance.
Is revision surgery common over a lifetime?
An implanted mechanical continence device can require later revision or removal because of malfunction, infection, erosion, recurrent leakage or tissue change. The possibility of future surgery should form part of the initial consent discussion.
Why does this page not compare artificial sphincter brands or models?
This page provides general education about a medical-device class and the associated surgical service. Product-specific suitability, availability, instructions, risks and device selection are discussed with an individual patient as part of clinical assessment and informed consent.
MALE CONTINENCE & RECONSTRUCTIVE UROLOGY
Continence surgery planned around the bladder and the urethra
Dr Jack Crozier is a Brisbane urologist whose practice includes neuro-urology and urinary reconstruction. Assessment before artificial sphincter surgery considers not only the severity of leakage, but also urethral tissue quality, previous radiation or reconstruction, bladder storage and emptying, and the practical ability to operate an implanted pump.
These factors become especially important in men with previous urethral stricture surgery, pelvic radiation, neurological bladder dysfunction or prior continence-device complications.
INDIVIDUAL CONTINENCE ASSESSMENT
Is stress urinary leakage still affecting daily life?
If leakage persists after prostate or pelvic treatment, or continence planning is complicated by radiation, urethral surgery or neurological disease, individual assessment can clarify the cause of leakage and the reasonable treatment options.