What Is an Artificial Urinary Incontinence Control Device (Artificial Urinary Sphincter)? How Does the Treatment Process Work?

What Causes Urinary Incontinence and What Does This Device Do?

There is a ring-shaped muscle surrounding the urinary tract that helps us hold urine. This structure is called the urinary sphincter. It works much like a faucet: it normally remains closed, then relaxes when we go to the toilet, allowing urine to pass.

After prostate surgery performed for prostate cancer, this muscle may become weakened or may no longer function adequately in some patients. As a result, urine leakage may occur when coughing, sneezing, lifting something heavy, or standing up. This is known as stress urinary incontinence.

The good news is that, in most patients, this problem improves significantly over time, particularly during the first 6–12 months, either on its own or with pelvic floor exercises (Kegel exercises). However, some patients continue to experience urinary leakage even after this period and despite trying all non-surgical treatment options. In these cases, quality of life can be significantly affected; patients may withdraw from social activities and need to use pads continuously.

This is where the artificial urinary incontinence control device (artificial urinary sphincter, or AUS) comes into play. This device is implanted inside the body and takes over the function of a weakened or non-functioning urinary sphincter. It has been used for decades and is a well-established treatment with known reliability and effectiveness.

Below, you can find answers to some of the most frequently asked questions about this device.

What Is the Device and How Does It Work?

What does the device look like and how many components does it have?

It is a closed system consisting of three components connected by thin tubes:

• Cuff: A small fluid-filled ring placed around the urethra. It gently keeps the urethra closed.

• Pump: A small button-like device placed inside the scrotum that can be squeezed with the fingers.

• Pressure-regulating balloon: A small reservoir placed in the abdomen that regulates pressure within the system.

None of these components are visible from the outside, as they are all positioned beneath the skin. Only the pump can be felt by hand inside the scrotum.

How is it used?

The system normally remains in the “closed” position, meaning that the cuff gently compresses the urethra and prevents urine leakage. When you want to urinate, you squeeze the pump in the scrotum a few times. This transfers fluid out of the cuff, allowing it to loosen so that you can urinate comfortably.

The device then automatically refills within approximately 2–3 minutes, closing the urethra again. In other words, the only thing you need to do before each visit to the toilet is squeeze the pump.

Does this device completely eliminate urinary incontinence?

When used in appropriately selected patients, the vast majority are satisfied with the results. Some patients become completely dry, while others may continue to experience very mild leakage of only a few drops per day.

This level of leakage generally does not significantly affect everyday life. The main goal is to substantially reduce pad use and the social concerns associated with urinary leakage.

Who Is It Suitable For?

Who is this device suitable for?

It is primarily suitable for men who continue to experience moderate to severe urinary incontinence following prostate surgery.

It may also be used in patients who have not achieved sufficient improvement with pelvic floor exercises, medication, or sling surgery, as well as in selected patients with certain neurological causes of urinary sphincter dysfunction.

Can it be used in everyone?

No. One important requirement is that you must be able to operate the device yourself.

You need sufficient hand strength to squeeze the pump between your thumb and index finger, and you must be able to understand and remember when and how to use the device. For this reason, these abilities are always assessed before surgery is recommended.

What assessments are performed before surgery?

First, the type and severity of urinary leakage need to be clearly determined.

The number and weight of pads used during the day, a voiding diary, and, when necessary, urodynamic testing (bladder pressure measurement) may be used.

In addition, cystoscopy (endoscopic examination of the urinary tract) may be performed to assess the condition of the urethra.

These evaluations help ensure that the correct treatment decision is made and that an appropriate cuff size is selected during surgery.

How is it different from sling surgery?

In sling surgery, the urethra is supported using a special band. This support is fixed and does not open or close.

Sling procedures may be preferred in cases of mild to moderate urinary incontinence.

An artificial urinary sphincter, however, is an active system that can be opened and closed when needed. It is particularly useful in more severe cases of urinary incontinence or when sling surgery has not provided adequate improvement.

The most appropriate option depends on the severity of urinary leakage and the patient’s expectations.

Surgery and Recovery Process

How is the surgery performed and how long does it take?

The procedure is performed under general or spinal anesthesia.

Through a small incision in the perineal area, the cuff is positioned around the urethra, the pump is placed inside the scrotum, and the pressure-regulating balloon is placed in the abdomen.

This approach is considered a reliable and effective method for performing this procedure.

The surgery usually takes several hours, and most patients are discharged after a short hospital stay.

Can I start using the device immediately after surgery?

No. This is a very important point.

After surgery, the device remains deactivated for approximately 4–6 weeks.

This period allows swelling in the surgical area to subside and gives the surrounding tissues time to heal securely around the device.

During this period, urinary leakage will continue, and you will still need to use pads. This is temporary and expected.

How is the device “activated”?

At the end of the healing period, you will return for a follow-up appointment.

The device is activated in the outpatient clinic through a painless procedure, and you will be shown step by step how to use the pump.

It is important to stay in contact with your doctor during the initial period of use so that you can ask any questions you may have.

Is it difficult to learn how to use?

It is normal to need some time to adjust during the first few days.

However, most patients incorporate the device into their daily routine within a few weeks and eventually use it almost automatically.

What should I pay attention to in daily life?

You can generally return to your normal daily activities.

There are, however, a few points to keep in mind. Take care with prolonged cycling because it may place direct pressure on the scrotum.

If you ever need surgery, another medical procedure, or urinary catheterisation in the future, you must inform the healthcare professional that you have an artificial urinary sphincter.

This information helps prevent accidental damage to the device.

It is also useful to carry your device identification card with you.

Is the device visible from the outside? Will other people notice it?

No. The entire device is located inside the body and is not visible externally.

Since the pump is positioned inside the scrotum, only you can feel it with your hand.

It is not noticeable through clothing or during normal daily activities.

How soon can I return to work after surgery?

For desk-based jobs, returning to work is generally possible within 2–3 weeks after the device has been activated.

For jobs involving heavy lifting or significant physical activity, a longer recovery period is usually recommended, typically around 4–6 weeks, to allow adequate tissue healing.

Your doctor will determine the appropriate timing based on your individual situation.

Will I experience urinary leakage while sleeping?

Because the device remains closed and continues to support urinary continence, it also functions during the night.

In some patients, however, a different usage approach may be recommended to reduce pressure on the tissues overnight rather than keeping the system continuously closed.

This decision is individual and will be determined by your doctor.

Will it cause problems at airport security?

The device generally does not cause problems with metal detectors.

However, carrying your device identification card can help you quickly explain the situation if any questions arise.

Can I have an MRI scan?

Devices currently in use are generally compatible with MRI scanning.

Nevertheless, you should always inform the imaging centre and the doctor requesting the MRI that you have an artificial urinary sphincter before the scan.

Risks, Device Lifespan and Follow-Up

What are the possible risks?

As with any surgical procedure involving an implanted medical device, there are certain risks.

These include infection, erosion of the surrounding tissue, mechanical failure, and the possible need for revision surgery in the future.

These complications are not common, but patients should be aware that they can occur before deciding to undergo surgery.

Does previous radiotherapy affect the outcome?

Yes.

In patients who have previously received radiotherapy to the area, the tissues may be more fragile, which can make healing more difficult.

Success rates may be somewhat lower, while the risks of infection, erosion, and additional surgery may be higher.

For this group of patients, careful treatment planning and a detailed discussion of expectations are particularly important.

Does the device last for a lifetime?

No. It is a mechanical device and has a limited lifespan.

Over the years, one of its components may need to be replaced, or the entire device may need to be renewed.

This does not necessarily mean that the surgery has “failed.” Like other medical devices, replacement after a certain period of use may be an expected part of long-term management.

Can the device be removed?

Yes, the device can be removed when necessary.

This is most commonly considered in cases of infection, erosion, or if the patient is dissatisfied with the device.

After removal, urinary leakage generally returns to the level experienced before surgery.

After an appropriate period of time, implantation of a new device or alternative treatment options may be considered.

Do I need regular follow-up appointments?

Yes.

Regular urological follow-up is important to ensure that the device continues to function properly over the long term and to identify any problems at an early stage.

If you notice an increase in urinary leakage, difficulty squeezing or emptying the pump, pain, or redness in the area, you should contact your doctor without waiting for your next scheduled appointment.

Common Misconceptions

“Urinary incontinence after prostate surgery is inevitable and never improves.”Most patients experience significant improvement over time. Persistent and severe urinary incontinence affects a smaller group of patients, and effective treatment options are available for these cases.

“I will become dry immediately after the device is implanted.”A healing period of approximately 4–6 weeks is required before the device is activated.

“Once it is implanted, it never needs to be touched again.”Because it is a mechanical device, one or more components may need to be replaced over time. This can be managed through regular follow-up.

Questions You Can Ask Your Doctor

During your consultation, you may want to ask:

Is the severity of my urinary incontinence suitable for this device, or should another treatment be tried first?

How many weeks will I need to wait after surgery?

How will my daily life be affected during this period?

What should I know about the lifespan of the device and the possibility of future replacement?

Short Summary

• An artificial urinary incontinence control device, also known as an artificial urinary sphincter, is an implanted system that takes over the function of a weakened urinary sphincter.

• It consists of three components: a cuff placed around the urethra, a pump located in the scrotum, and a pressure-regulating balloon positioned in the abdomen. The device is not visible externally.

• To urinate, the pump in the scrotum is squeezed. The device automatically closes again within approximately 2–3 minutes.

• It is most commonly used in men with persistent moderate to severe urinary incontinence following prostate surgery.

• Adequate hand strength and the ability to understand and correctly operate the device are required.

• After surgery, the device remains deactivated for approximately 4–6 weeks. Urinary leakage continues during this period, which is expected.

• Because it is a mechanical device, its components may need to be replaced over time, and regular follow-up is important.