Urinary Incontinence Surgeries

6. Artificial Urinary Sphincter

An artificial urinary sphincter is an implanted device designed to control urine flow by providing artificial compression around the urethra.

It is particularly important in the management of moderate-to-severe male stress urinary incontinence, including cases that occur after prostate surgery.

The device typically consists of a cuff around the urethra, a control pump, and a pressure-regulating balloon. The patient activates the pump when they need to urinate, allowing the cuff to temporarily open.

The EAU describes the artificial urinary sphincter as the standard treatment for moderate-to-severe male stress urinary incontinence. Patients should understand that the device can require revision or replacement over time and that successful use depends on being able to operate the pump.

How Is the Right Surgery Chosen?

The most suitable procedure is not the same for every patient. A urologist may consider:

• Type of urinary incontinence
• Severity and frequency of leakage
• Age and general health
• Previous pelvic or prostate surgery
• Previous incontinence treatments
• Pelvic organ prolapse, when present
• Bladder emptying ability
• Urethral and sphincter function
• Previous radiation treatment
• Patient preferences and expectations

In women with mixed urinary incontinence, treatment can be more complex because surgery for the stress component may not eliminate urgency-related symptoms. Current EAU guidance recommends discussing this possibility before surgery.

Tests Before Urinary Incontinence Surgery

A urological assessment usually begins with a detailed medical history and physical examination. Depending on the symptoms, the doctor may recommend:

• Urine testing
• Bladder diary
• Assessment of urine leakage
• Measurement of post-void residual urine
• Ultrasound
• Cystoscopy in selected cases
• Urodynamic testing when clinically indicated