An artificial urinary sphincter (AUS) is a medical device used to treat urinary incontinence in individuals, typically those who have had surgery or experienced trauma that has damaged the natural urinary sphincter. The urinary sphincter is a muscle that controls the release of urine from the bladder into the urethra and out of the body. When the natural urinary sphincter is unable to function properly, it can lead to urinary incontinence, where a person experiences involuntary urine leakage. In this article, I will talk about AUS complications and treatment.

Components of AUS

An AUS is designed to mimic the function of the natural urinary sphincter by providing control over the flow of urine. It consists of several components, including:

1. A cuff: This is a flexible, inflatable ring that is placed around the urethra, near the bladder neck.
2. A pressure-regulating balloon: This is implanted in the abdomen or pelvic region and is connected to the cuff. The balloon is filled with a sterile fluid.
3. A control pump: Usually placed in the scrotum in men or the labia majora in women, this pump allows the patient to manually control the inflation and deflation of the cuff.

The way an AUS works is as follows:

• When the patient wants to urinate, they squeeze the control pump to deflate the cuff, allowing urine to flow from the bladder to the urethra.
• After urination, the cuff automatically re-inflates, closing off the urethra to prevent urine leakage.

This mechanism allows the patient to regain control over their urinary function, effectively managing urinary incontinence. AUS implantation is typically considered when other non-surgical treatments for incontinence have been unsuccessful.

It’s important to note that the implantation of an artificial urinary sphincter is a surgical procedure that requires careful evaluation, patient counseling, and follow-up care to ensure its effectiveness and minimize potential complications. Patients with AUS should be trained on how to use the control pump and be aware of any signs of malfunction or infection, which may require medical attention.

What should patients with AUS pay attention to?

Patients with an artificial urinary sphincter (AUS) should pay close attention to several important aspects of their care to ensure the proper functioning of the device and to minimize the risk of complications. Here are some key things that AUS patients should be vigilant about:

1. Follow Postoperative Instructions: After AUS implantation surgery, patients should closely follow the postoperative instructions provided by their urologist or healthcare provider. This may include guidelines for catheter use, wound care, and activity restrictions during the initial healing period.

• Learn to Use the Control Pump: Patients should be thoroughly trained on how to use the control pump that inflates and deflates the AUS cuff. Proper technique for using the pump is crucial to control urination effectively.

3. Recognize Signs of Erosion: AUS erosion is a potential complication. Patients should be aware of the signs and symptoms of erosion, which may include pain, discomfort, visible protrusion of AUS components, or urinary leakage. If any of these symptoms occur, patients should seek immediate medical attention.
4. Monitor for Infections: Infections can weaken the surrounding tissues and increase the risk of AUS erosion. Patients should be vigilant for signs of infection, such as fever, pain, redness, swelling, or drainage at the surgical site, and report these symptoms to their healthcare provider promptly.
5. Attend Regular Follow-Up Appointments: Regular follow-up appointments with a urologist are essential for AUS patients. These appointments allow healthcare providers to assess the function of the AUS, monitor for complications, and make any necessary adjustments to the device.
6. Keep the Area Clean: Maintaining good hygiene around the AUS components is important to prevent infections. Patients should follow hygiene guidelines provided by their healthcare provider and keep the area clean and dry.
7. Be Prepared for Emergencies: Patients should have a plan in place for managing their AUS in case of emergencies. This may include knowing how to deflate the cuff manually in the event of a malfunction or pump failure.
8. Communicate with Healthcare Provider: Any concerns or issues related to the AUS should be promptly communicated to the healthcare provider. Open and transparent communication can help address problems early and ensure proper care.
9. Maintain a Healthy Lifestyle: Leading a healthy lifestyle can contribute to overall well-being and may help improve urinary function. This includes maintaining a balanced diet, staying hydrated, engaging in regular physical activity, and avoiding habits that can exacerbate urinary symptoms, such as excessive caffeine or alcohol consumption.
10. Stay Informed: Patients should educate themselves about the AUS and understand its function and limitations. Having a good understanding of their condition and treatment can empower patients to make informed decisions about their care.

1. It’s important for AUS patients to have a strong partnership with their urologist and healthcare team to ensure ongoing care and support. Regular communication, adherence to medical advice, and vigilance in monitoring for any issues are key to successful management with an AUS.

What are the complications AUS?

An artificial urinary sphincter (AUS) can be an effective treatment for urinary incontinence, but like any medical intervention, it can be associated with potential complications. These complications can vary in severity and may occur in some patients while not in others. It’s essential for patients and healthcare providers to be aware of these potential complications and to monitor for them carefully. Some common complications of AUS include:

1. Erosion: Erosion is one of the most significant complications associated with AUS. It occurs when one or more components of the device, such as the cuff, balloon, or tubing, erode through the surrounding tissues, potentially leading to infection, discomfort, and device malfunction.
2. Infection: Infections can occur at the surgical site or in the area surrounding the AUS. Infection can weaken the tissues, increase the risk of erosion, and lead to other complications.
3. Device Malfunction: AUS components, including the cuff, pump, or tubing, can malfunction over time. This can result in difficulty controlling urination, leakage, or discomfort. Device malfunction may require device removal and replacement.
4. Hematoma or Bleeding: Hematoma or excessive bleeding at the surgical site can occur during or after AUS implantation surgery.
5. Urinary Retention: Some patients may experience difficulty emptying their bladder completely due to AUS implantation, which can lead to urinary retention.
6. Pain or Discomfort: Patients may experience pain or discomfort in the surgical area, particularly in the immediate postoperative period.
7. Mechanical Failure: The control pump or other mechanical components of the AUS can fail, leading to difficulties in inflating or deflating the cuff.
8. Reoperation: Patients may require reoperation for various reasons, such as to address complications, revise the AUS placement, or replace malfunctioning components.
9. Adverse Reactions: Some patients may experience adverse reactions to the materials used in the AUS, leading to allergic responses or discomfort.
10. Adjustment Issues: Proper use of the control pump is crucial for effective AUS function. Patients may experience difficulties or challenges in using the pump correctly.
11. Device Extrusion: Rarely, the entire AUS device may extrude or migrate from its original implantation site.
12. Overactive Bladder: In some cases, AUS may lead to overactive bladder symptoms, including urgency and frequency of urination.

It’s important to note that while complications are possible, they do not occur in every patient, and many individuals with AUS experience significant improvement in urinary control and quality of life. Careful patient selection, proper surgical technique, and diligent postoperative care can help minimize the risk of complications. Patients with AUS should maintain regular follow-up appointments with their healthcare provider to monitor the device’s function and address any potential issues promptly.

What is erosion of artificial urinary sphincter?

Erosion of an artificial urinary sphincter (AUS) is a potential complication associated with the use of this medical device. AUS erosion occurs when one or more of the components of the artificial urinary sphincter, such as the cuff, balloon, or tubing, erodes through the tissues surrounding it and becomes exposed or visible. This can lead to various problems, including infection, discomfort, and reduced effectiveness of the AUS.

Erosion of an artificial urinary sphincter can occur for several reasons:

1. Tissue breakdown: The constant pressure or friction of the AUS components against the surrounding tissues can lead to tissue breakdown, eventually causing erosion.
2. Infection: Infection at the site of the AUS implantation can weaken the tissues and contribute to erosion.
3. Component failure: A malfunction or failure of one of the AUS components, such as the cuff or tubing, can lead to erosion.
4. Surgical technique: Improper surgical placement or inadequate tissue coverage during AUS implantation can increase the risk of erosion.

Symptoms of AUS erosion may include pain, discomfort, visible protrusion of AUS components, infection, and urinary leakage. If erosion is suspected, it is essential to seek medical attention promptly to assess the situation and determine the appropriate course of action.

Preventing AUS erosion is crucial, and this often involves careful patient selection, proper surgical technique, and diligent postoperative care. Patients with an AUS should also be educated on how to recognize signs of erosion or infection and instructed on when to seek medical attention.

It’s important to note that while AUS erosion is a potential complication, it is relatively uncommon when the device is properly implanted and monitored. Patients considering an artificial urinary sphincter should discuss the potential risks and benefits with their healthcare provider to make an informed decision about treatment for urinary incontinence.

What are the risk factors for erosion of artificial urinary sphincter?

Several factors can contribute to the risk of erosion of an artificial urinary sphincter (AUS). Erosion occurs when one or more components of the AUS erode through surrounding tissues and become exposed. Understanding these risk factors can help healthcare providers and patients make informed decisions and take preventive measures to minimize the chances of erosion. Some of the risk factors for AUS erosion include:

1. Surgical Technique: The surgical placement of the AUS is a critical factor. A lack of proper surgical technique, inadequate tissue coverage of the AUS components, or improper cuff placement can increase the risk of erosion.
2. Previous Surgeries: Patients who have undergone multiple pelvic or urological surgeries may have scar tissue or altered anatomy that makes AUS implantation more challenging and increases the risk of complications, including erosion.
3. Tissue Quality: The quality and health of the surrounding tissues play a role in the risk of erosion. Conditions like tissue thinning or scarring from previous surgeries can increase the likelihood of erosion.
4. Infection: Infections at the surgical site or in the area of the AUS can weaken the surrounding tissues, making them more prone to erosion. It’s crucial to manage and treat any infections promptly.
5. Chronic Inflammation: Conditions associated with chronic inflammation, such as radiation therapy or chronic urinary tract infections, can contribute to tissue damage and erosion.
6. Previous Erosion: Patients who have experienced AUS erosion in the past may be at a higher risk of recurrence, and additional preventive measures may be necessary in such cases.
7. Patient Anatomy: The anatomical characteristics of the patient, such as the size and shape of the urethra and the condition of the surrounding tissues, can influence the risk of erosion.
8. Age: Some studies suggest that older age may be associated with a higher risk of AUS erosion, possibly due to age-related changes in tissue quality.
9. Mechanical Failure: Malfunctions or issues with the AUS device itself, such as cuff over-inflation or pump failure, can contribute to erosion.
10. Surgical Experience: The experience and skill of the surgeon performing the AUS implantation can impact the risk of complications, including erosion. Surgeons with more experience in AUS procedures may have lower complication rates.

It’s essential for healthcare providers to carefully assess the patient’s suitability for AUS implantation, considering these risk factors, and provide appropriate preoperative counseling and education to the patient. Regular follow-up appointments after AUS implantation are crucial for monitoring the device’s function and detecting any potential issues early. Patients should also be educated on the signs and symptoms of erosion so they can seek prompt medical attention if necessary.

How to treate erosion of artificial urinary sphincter?

The treatment of erosion of an artificial urinary sphincter (AUS) typically involves a combination of surgical interventions, management of infection (if present), and long-term follow-up care. The specific approach to treating AUS erosion may vary depending on the extent of the erosion, the patient’s overall health, and the underlying causes. Here are the steps commonly taken to address AUS erosion:

1. Evaluation and Diagnosis: The first step is to confirm the diagnosis of AUS erosion through a physical examination and imaging studies, such as ultrasound, cystoscopy, or MRI, to assess the extent of the erosion and identify any associated complications like infection.
2. Infection Management: If there is an infection associated with the erosion, it is crucial to treat the infection first. This may involve administering antibiotics and ensuring that the infection is completely cleared before proceeding with any surgical intervention.
3. Device Removal: In most cases of AUS erosion, the eroded components of the device need to be surgically removed. This may involve removing the cuff, balloon, or tubing that has eroded through the surrounding tissues.
4. Repair or Replacement: Depending on the extent of the damage, the eroded tissues may need to be repaired surgically. This can involve reconstructing the damaged area, closing the wound, and providing additional tissue coverage. In some cases, the AUS may need to be replaced with a new device if it cannot be salvaged.
5. Revision Surgery: After the removal and repair or replacement of the AUS components, a revision surgery may be necessary to re-implant a new AUS or adjust the existing device to ensure proper function.
6. Postoperative Care: Patients will require postoperative care and monitoring to ensure proper healing and function of the AUS. This may involve catheterization for a period of time to allow the surgical site to heal and the urinary system to recover.
7. Long-Term Follow-Up: Regular follow-up appointments with a urologist are essential to monitor the AUS function, assess for any signs of recurrence of erosion, and address any complications that may arise.

It’s important to note that the management of AUS erosion can be complex, and the specific treatment plan may vary from one case to another. The choice of treatment will depend on the individual patient’s circumstances, the extent of tissue damage, and the surgeon’s judgment.

Conclusion

AUS is an effective treatment method for patients with urinary incontinence. There are late complications, although rare. Sphincter erosion requires surgical treatment. Preventing AUS erosion in the first place is a priority, and this involves careful patient selection, experienced surgical technique, and diligent postoperative care. Patients with AUS should be educated about the signs and symptoms of erosion and infection and instructed on when to seek medical attention promptly. Choosing an experienced and skilled urologist for AUS implantation and follow-up care can also help minimize the risk of complications.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY