The complete surgical spectrum of artificial urinary sphincter management for stress incontinence, including primary insertion, complex structural revision, and mechanical repairs. This specializes in addressing long-term component wear, fluid volume degradation, urethral atrophy beneath the compression cuff, device deactivation jams, or rare erosion complications requiring cuff relocation.

Clinical Indication

This procedure is highly indicated for patients experiencing structural anomalies, severe localized scar tissue, or functional blockages that fail to resolve with initial conservative therapeutic adjustments.

Surgical Objective

The principal objective is the complete restoration of physiological form, functional urinary path independence, or mechanical integrity, maximizing long-term outcomes while minimizing systemic downtime.

The Artificial Urinary Sphincter (AUS; AMS 800™) remains the worldwide benchmark and gold standard for the definitive management of moderate to severe male stress urinary incontinence (SUI). The device consists of three silicone elastomer components: an occlusive urethral cuff, a discreet scrotal control pump, and a pressure-regulating balloon (PRB) placed within the lower abdominal cavity. By circumferentially compressing the bulbar urethra, it restores passive continence while allowing normal, unobstructed voluntary voiding upon cycling the scrotal pump.

Clinical Indications & Patient Selection

AUS implantation is indicated for persistent, bothersome stress incontinence resulting from intrinsic sphincter deficiency (ISD) that has failed conservative pelvic floor rehabilitation.

Post-Prostatectomy Stress Incontinence: Intrinsic sphincter deficiency following robotic radical prostatectomy or open retropubic prostatectomy.

Post-Radiation Sphincter Incompetence: Severe leakage after salvage prostatectomy or primary radiation therapy where sling options have unacceptably high failure rates.

AUS Revision / Component Salvage: Patients with recurrent incontinence due to urethral cuff atrophy, micro-fluid leakage from the balloon, or urethral erosion requiring surgical revision.

Surgical Technique & Procedural Nuance

Performed through a small perineal incision and a secondary lower abdominal or scrotal counter-incision with meticulously measured cuff sizing.

Bulbar Urethral Mobilization: Circumferential dissection of the proximal bulbar urethra with preservation of dorsal bulbospongiosus neurovascular elements.

Accurate Cuff Sizing (3.5 cm to 4.5 cm): Precise measurement to avoid overly tight compression (which risks tissue erosion) or loose sizing (which results in persistent incontinence).

Transcorporeal Cuff Placement: In patients with prior radiation, thin urethral spongiosum, or prior eroded cuffs, the cuff is placed transcorporeally—passing a segment of tunica albuginea beneath the urethra to cushion and vascularize the cuff bed.

Postoperative Pathway & Recovery Timeline

The device is intentionally left deactivated for 6 weeks postoperatively to allow the peri-urethral tissue to fully heal without pressure ischemia.

Deactivation Period: The patient continues using pads for 6 weeks while the cuff remains open and benignly seated in the perineum.

In-Office Activation: At 6 weeks, the doctor verifies painless healing and un-pops the deactivation button on the scrotal pump, teaching the patient the simple squeeze-to-void technique.

Activity Guidelines: Avoid cycling, straddle activities, and heavy lifting for 6 weeks.

Outcomes, Durability & Clinical Evidence

AUS implantation dramatically transforms quality of life for men suffering from profound post-prostatectomy incontinence.

Social Continence: Most men reach ‘social continence’ (0 to 1 security pad per day) and can be more active.

Long-Term Device Reliability: The device lasts many years in most men; some need a revision later, often for tissue thinning under the cuff.

The Artificial Urinary Sphincter (AUS; AMS 800™) remains the worldwide benchmark and gold standard for the definitive management of moderate to severe male stress urinary incontinence (SUI). The device consists of three silicone elastomer components: an occlusive urethral cuff, a discreet scrotal control pump, and a pressure-regulating balloon (PRB) placed within the lower abdominal cavity. By circumferentially compressing the bulbar urethra, it restores passive continence while allowing normal, unobstructed voluntary voiding upon cycling the scrotal pump.

Clinical Indications & Patient Selection

AUS implantation is indicated for persistent, bothersome stress incontinence resulting from intrinsic sphincter deficiency (ISD) that has failed conservative pelvic floor rehabilitation.

Post-Prostatectomy Stress Incontinence: Intrinsic sphincter deficiency following robotic radical prostatectomy or open retropubic prostatectomy.

Post-Radiation Sphincter Incompetence: Severe leakage after salvage prostatectomy or primary radiation therapy where sling options have unacceptably high failure rates.

AUS Revision / Component Salvage: Patients with recurrent incontinence due to urethral cuff atrophy, micro-fluid leakage from the balloon, or urethral erosion requiring surgical revision.

Surgical Technique & Procedural Nuance

Performed through a small perineal incision and a secondary lower abdominal or scrotal counter-incision with meticulously measured cuff sizing.

Bulbar Urethral Mobilization: Circumferential dissection of the proximal bulbar urethra with preservation of dorsal bulbospongiosus neurovascular elements.

Accurate Cuff Sizing (3.5 cm to 4.5 cm): Precise measurement to avoid overly tight compression (which risks tissue erosion) or loose sizing (which results in persistent incontinence).

Transcorporeal Cuff Placement: In patients with prior radiation, thin urethral spongiosum, or prior eroded cuffs, the cuff is placed transcorporeally—passing a segment of tunica albuginea beneath the urethra to cushion and vascularize the cuff bed.

Postoperative Pathway & Recovery Timeline

The device is intentionally left deactivated for 6 weeks postoperatively to allow the peri-urethral tissue to fully heal without pressure ischemia.

Deactivation Period: The patient continues using pads for 6 weeks while the cuff remains open and benignly seated in the perineum.

In-Office Activation: At 6 weeks, the doctor verifies painless healing and un-pops the deactivation button on the scrotal pump, teaching the patient the simple squeeze-to-void technique.

Activity Guidelines: Avoid cycling, straddle activities, and heavy lifting for 6 weeks.

Outcomes, Durability & Clinical Evidence

AUS implantation dramatically transforms quality of life for men suffering from profound post-prostatectomy incontinence.

Social Continence: Most men reach ‘social continence’ (0 to 1 security pad per day) and can be more active.

Long-Term Device Reliability: The device lasts many years in most men; some need a revision later, often for tissue thinning under the cuff.

Related Conditions & Patient Recovery Protocols

Clinical Subspecialty Hub: Urinary Incontinence & Voiding Restoration →

Underlying Clinical Condition: Male Urinary Incontinence →

Underlying Clinical Condition: Artificial Urinary Sphincter Complications →

Underlying Clinical Condition: Radiation-Induced Urologic Complications →

When leakage continues with a working sphincter

Some men still leak after an artificial urinary sphincter even though the device is working. Often the cause is an overactive bladder: sudden urges and leakage on the way to the bathroom (urge incontinence). This is common in men treated for prostate cancer, especially after radiation, and it is treated separately with medication, bladder Botox, or nerve stimulation.