Urination occurs when muscles in the bladder tighten to facilitate the flow of urine out of the body through the urethra. Spinal nerves also play a role in controlling bladder muscles. If anything happens that disrupts the way nerves and muscles communicate in this area, it could result in urine leaks.
If common treatments such as medication and bladder training exercises are ineffective, a silicone cuff referred to as an artificial urinary sphincter (AUS) may allow the urethra to be sufficiently sealed off at the point where it meets the bladder until urination is necessary.
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The system includes an inflatable cuff that's placed where the bladder connects to the urethra. A balloon is inserted in the pelvic area to regulate the pressure that is placed on the cuff by the user. The pump that's used to inflate or deflate the balloon to complete urination as needed is located in the scrotum. With some systems, the cuff refills automatically after urination to close off the urethra from the bladder again.
Performed with either general or spinal anesthesia, surgery to install the AUS system requires a few small incisions. One incision is made in lower part of the abdomen to insert the pressure-regulating balloon. Another incision is made in the area between the rectum and scrotum for the pump. AUS insertion is sometimes done as an outpatient procedure. A catheter is also inserted to allow for urine drainage immediately after AUS surgery. A urologist will remove it during a follow-up visit. It usually takes a few hours to complete the procedure.
About 4 to 6 weeks after AUS surgery, patients return to the urologist's office to have the system activated. The reason for the delay in activation is to give tissues time to heal, especially in the scrotum since this is the area users will need to press to urinate. Use of the device requires manual dexterity. However, most patients eventually get used to using the AUS.
Shortly after AUS placement, patients are usually instructed to drink more water and to avoid any strenuous activities as the incisions heal. Initially, the pump may shift out of place during normal movements. To minimize this issue, patients may be told to pull the pump down in the lower part of the scrotum until it naturally stays in place. Some patients may experience leaks until activation. If minor urine leakage occurs, this is normal and it should go away after activation of the AUS system.
While surgery to insert an artificial urinary sphincter is often done when urinary incontinence symptoms are severe or when leakage of urine is constant, it may also be an option for men who develop UI after prostate removal or other types of prostate surgery. When performed for this purpose, the treatment has a high success rate. Most men report being satisfied with the AUS system following surgery and recovery. Side effects and risks associated with the procedure are generally considered mild and minimal.
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