Male continence surgery · Brisbane
Artificial Urinary Sphincter Surgery.
An artificial urinary sphincter is an implanted device designed to improve bladder control in selected men with stress urinary incontinence.
It is most commonly considered when urinary leakage persists after prostate surgery, particularly when conservative treatments have not provided sufficient improvement.
Southside Urology provides specialist assessment of male urinary incontinence, including consideration of artificial sphincter surgery, previous prostate treatment, urethral reconstruction and complex bladder conditions.
Understanding male incontinence
What is an artificial urinary sphincter?
An artificial urinary sphincter, often called an AUS, is a surgically implanted device that helps reduce involuntary urine leakage caused by weakness of the urinary sphincter.
Normally, the urinary sphincter helps maintain closure of the urethra while urine is stored in the bladder.
After prostate surgery or other pelvic treatment, this natural closing mechanism may be weakened, allowing urine to leak during coughing, walking, exercise or other physical activities.
An AUS uses an inflatable cuff around the urethra to provide additional resistance and improve continence.
The patient operates a small pump within the scrotum when they need to pass urine.
The implant is completely internal and does not require an external control or battery in a traditional hydraulic design.
What is the operation designed to achieve?
- Reduce activity-related urinary leakage
- Improve control of urine storage between voids
- Allow deliberate urination using a scrotal pump
- Reduce reliance on continence pads in appropriately selected patients
- Improve practical daily bladder management
The operation does not guarantee complete dryness, and it is not the appropriate treatment for every type of urinary leakage.
Choosing the correct treatment
Stress incontinence and urgency incontinence are different.
Distinguishing these causes of leakage is one of the most important steps before continence surgery.
Stress urinary incontinence
Urine leaks when physical activity increases pressure on the bladder and the sphincter cannot maintain closure.
- Coughing or sneezing
- Standing or walking
- Lifting or exercising
- Changes in body position
An AUS is primarily designed to treat this type of leakage.
Urgency urinary incontinence
Urine leaks after a sudden, difficult-to-delay need to pass urine, often due to bladder overactivity.
- Sudden urgent need to urinate
- Leakage on the way to the toilet
- Frequent urination
- Night-time bladder symptoms
Urgency may require bladder-directed treatment rather than artificial sphincter surgery.
Yes. Some men have mixed urinary incontinence, with both sphincter weakness and bladder overactivity.
An artificial sphincter may improve the stress component while urgency symptoms remain. Both mechanisms should be understood before surgery.
Who may be suitable?
When might artificial urinary sphincter surgery be considered?
The procedure is commonly considered for persistent male stress incontinence, particularly moderate-to-severe leakage after prostate treatment. Selected other situations may also warrant assessment.
Persistent leakage after prostatectomy
Sphincter weakness can cause ongoing urinary leakage after radical prostatectomy.
Surgery may be considered when recovery has plateaued and symptoms remain troublesome.
Incontinence after other procedures
Some men develop stress leakage following treatment for benign prostate enlargement or other prostate conditions.
Incontinence with radiation history
An AUS may be considered after radiation treatment, but tissue changes can increase the risk of complications and future revision.
Previous urethral or pelvic surgery
Selected patients may be considered after reconstructive surgery, although urethral blood supply and scar tissue affect suitability and risk.
Selected neurological incontinence
AUS surgery may have a role in selected neurogenic sphincter weakness, after careful assessment of bladder pressure and emptying.
Leakage after previous continence surgery
Previous male sling or AUS surgery may require reassessment of the urethra, bladder and existing treatment before further surgery.
Device components
How does an artificial urinary sphincter work?
A traditional three-component system contains an inflatable cuff, a control pump and a pressure-regulating balloon. The components are connected by fluid-filled tubing.
Urethral cuff
The cuff is positioned around a selected part of the urethra.
When filled, it provides controlled pressure to help reduce urine leakage between voids.
Scrotal control pump
A small pump is placed within the scrotum.
The patient operates the pump to temporarily reduce cuff pressure when they need to urinate.
Pressure-regulating balloon
This fluid-containing component helps regulate cuff pressure within the system.
Its placement depends on the device design, anatomy and previous surgery.
Three stages of everyday operation
The cuff provides outlet resistance while the bladder stores urine.
Fluid moves away from the cuff, temporarily reducing pressure around the urethra.
The hydraulic system gradually returns toward its resting configuration.
A traditional hydraulic AUS does not require batteries, an external controller or electronic charging.
Patients receive practical training on their particular device after healing. This page is not a device operating manual.
Before considering surgery
What investigations are needed before an artificial sphincter?
Assessment aims to confirm the type of incontinence, identify any bladder or urethral problems, and determine whether the device can be used safely.
Continence history
Review when leakage occurs, pad use, urgency, night-time symptoms, previous prostate treatment and impact on everyday activities.
Pad assessment and bladder diary
Pad use, a pad-weight test or bladder diary can help establish leakage severity and identify associated bladder-storage symptoms.
Bladder emptying assessment
Urine flow testing and post-void residual measurement may help identify impaired emptying or another urinary tract problem.
Cystoscopy
Endoscopic examination may be used to assess the urethra, bladder neck and possible strictures, particularly after previous surgery.
Urodynamic testing
Urodynamics may be particularly valuable when bladder overactivity, poor emptying or neurological bladder dysfunction is present.
Hand function and cognition
The patient must be able to locate and operate the scrotal pump reliably. Dexterity and understanding are important for long-term use.
Not every patient requires every test. Investigations are selected according to the symptoms, previous treatment, existing results and complexity of the urinary tract.
Active infection, significant urethral obstruction or unsafe bladder-storage pressures may need treatment before continence surgery is considered.
Comparing continence treatments
Artificial urinary sphincter versus male sling.
Both are established surgical approaches for selected male stress incontinence, but suitability and mechanism differ.
An implanted controllable cuff
An AUS provides adjustable opening during urination through a manually operated pump.
- Commonly considered for moderate-to-severe leakage
- May be considered following radiotherapy, with higher complication risks
- Requires sufficient hand function and cognition
- Involves implanted mechanical components
- Future revision or replacement may be required
Support or repositioning of the urethra
A male sling supports or compresses the urethra without a manually operated pump.
- Often considered for mild-to-moderate stress leakage
- Generally less suitable for severe leakage
- Previous radiotherapy may reduce the likelihood of success
- Does not require manual activation for each void
- Persistent leakage may require further continence treatment
The severity of leakage, previous radiotherapy, urethral anatomy, bladder function and personal priorities all matter.
An artificial sphincter is generally favoured for moderate-to-severe stress incontinence. A sling may be considered in selected men with less severe leakage.
The presence of a previous sling does not necessarily exclude later AUS surgery.
The surgical procedure
What happens during artificial sphincter surgery?
Implantation is performed under anaesthesia at a hospital or appropriate surgical facility. The surgical approach depends on the patient's anatomy and prior treatment.
Preoperative planning
The surgeon reviews urinary function, previous prostate or urethral surgery, radiation and infection risks.
Cuff placement
The urethra is exposed through an appropriate incision and measured for cuff placement.
Pump and balloon
The control pump and pressure-regulating component are placed, connected and the system is checked.
Closure and healing
The wounds are closed. The device is generally left deactivated during the early healing period.
The cuff is usually left deactivated to allow healing and limit pressure on recently operated tissues.
Urinary leakage may therefore continue immediately after surgery until the device is activated at a subsequent review.
Healing and activation
What is recovery like after AUS surgery?
Recovery involves initial wound healing followed by a separate appointment for device activation and practical instruction.
Wound healing
Bruising, swelling and discomfort may occur around the perineum, scrotum or incision sites.
Urinary drainage may be required temporarily, depending on the surgical circumstances.
Recovery before activation
Activity restrictions, wound care and follow-up are guided by the treating surgical team.
The device normally remains inactive while swelling and tissues heal.
Activation and training
Activation often takes place around four to six weeks after surgery, but timing varies by surgeon and healing.
The patient is taught how to find and operate the pump safely.
Walking and light activities are generally reintroduced during recovery, while heavier exercise, cycling, lifting and activities that place pressure on the perineum may need to be restricted initially.
Return to work, driving, exercise and sexual activity should follow the individual instructions provided by the treating surgeon.
Important: urinary catheterisation after artificial sphincter surgery
Always tell healthcare professionals that you have an artificial urinary sphincter before a catheter is passed through the urethra.
Urethral instrumentation or catheterisation with the cuff closed can cause serious urethral injury, including cuff erosion.
The device must be managed appropriately, generally including deactivation before urethral instrumentation by a trained clinician. Catheter choice and any alternative drainage arrangements require clinical assessment.
If you cannot pass urine or require emergency care, seek urgent medical attention and immediately advise the treating team about the implant. Do not delay emergency assessment.
Risks and informed consent
What complications can occur with an artificial sphincter?
AUS surgery involves a mechanical implant placed around living urethral tissue. Problems may occur during early recovery or many years later.
Device infection
Infection involving implanted components may require surgical removal, antibiotics and later reconstruction or reimplantation.
Urethral erosion
The cuff can erode through the urethral wall. This is a serious complication commonly requiring device removal.
Mechanical malfunction
Components may fail or fluid may leak from the system, leading to recurrent urinary leakage.
Persistent or recurrent leakage
Some urinary leakage may remain after activation, or continence may deteriorate over time because of device, urethral or bladder changes.
Urinary retention
Problems with bladder emptying can occur, particularly when bladder contraction is weak or another obstruction is present.
Pump difficulties
The control pump may be difficult to access, painful, poorly positioned or difficult to operate.
Bleeding and wound problems
Bleeding, bruising, haematoma, pain, wound infection or delayed healing may occur.
Urethral tissue changes
Tissue quality and urethral coaptation may change over time, contributing to recurrent leakage.
Revision or removal
Mechanical failure, erosion, infection or changing anatomy may eventually require further surgery.
No implanted continence device has a guaranteed lifetime. Device performance and urethral tissue health can change with time.
Patients should understand that revision, component replacement or complete removal may eventually be necessary.
More complex surgical planning
What if you have had radiation, urethral surgery or an earlier implant?
Previous treatment can alter blood supply, tissue health and urethral anatomy. This can increase the complexity of implantation and revision.
Radiation-related tissue changes
Pelvic radiotherapy can affect tissue blood supply and healing. Prior radiation is associated with increased risk of certain AUS complications, particularly urethral erosion and subsequent intervention.
Radiation does not automatically exclude AUS surgery, but it changes the consent discussion and planning.
Previous stricture or urethroplasty
Urethral narrowing, previous reconstruction or repeated instrumentation can affect cuff placement and urethral tissue risk.
Additional evaluation may be needed before deciding whether and where an implant can be placed.
Previous cuff erosion
Following erosion or device removal, the urethra must be reassessed before any possible reimplantation.
Tissue scarring and previous surgical changes can substantially influence the available options.
Revision after device failure
Failure may involve mechanical problems, urethral change, pump position, infection or a different cause of incontinence.
The original operation and device history are useful in planning further assessment.
Neuro-urology and reconstruction
Artificial sphincters in neurological patients.
In selected neurological conditions, urinary leakage may result from weakness of the external urinary sphincter.
However, neurological bladder dysfunction may also affect bladder pressure, compliance, sensation and emptying.
Increasing resistance at the bladder outlet without understanding storage pressures can create additional urinary-tract risks.
Patients with spinal cord injury, spina bifida and other neurological conditions may therefore require particularly careful investigation and long-term bladder planning.
What additional factors matter?
- Bladder compliance and storage pressures
- Detrusor overactivity or other bladder dysfunction
- Ability to empty the bladder safely
- Need for intermittent catheterisation
- Hand function and pump accessibility
- Sensation, cognition and neurological progression
- Long-term upper urinary-tract safety
The bladder should be safe before the outlet is made tighter.
Long-term device management
What if leakage returns or the AUS stops working?
Recurrent urinary leakage does not always mean the implant has mechanically failed. The urethra, bladder and device may all need review.
Reassess symptoms
Establish whether leakage is mainly stress-related, urgency-related or associated with difficulty emptying.
Check device operation
Clinical assessment may identify pump or component problems and help decide whether further testing is needed.
Examine the urethra
Cystoscopy or other investigations may be indicated if erosion, stricture or urethral change is suspected.
Discuss further options
The plan may involve non-surgical management, component revision, replacement or device removal.
New scrotal redness, warmth, swelling, wound breakdown, device exposure, fever or significant pain require prompt medical assessment.
Suspected erosion or infection should not be managed as a routine elective device problem.
Specialist consultation
What happens at an AUS assessment appointment?
Your consultation aims to determine the cause of leakage, review previous treatment and explain the options that may be suitable.
History
Review urinary leakage, pad use, urgency, previous operations and medical history.
Examination
Assess relevant anatomy, previous scars, urethral concerns and pump operation where applicable.
Investigation
Consider selected urine, flow, cystoscopy or urodynamic testing based on clinical findings.
Treatment planning
Discuss non-surgical treatments, sling or AUS suitability, risks, recovery and expectations.
What should patients bring?
- GP or specialist referral
- Previous prostate operation reports
- Details of radiotherapy, if applicable
- Previous urethral or continence surgery records
- Existing AUS device details, if applicable
- Previous cystoscopy or urodynamics reports
- Approximate daily pad use
- Current medication and allergy list
Information for referring GPs
Please include the cause and duration of incontinence, pad usage, urgency symptoms and previous conservative treatment.
Document previous prostatectomy, radiotherapy, urethral stricture, urethroplasty or continence surgery.
Prior operative reports and relevant urodynamics may be particularly helpful.
Suspected implanted-device infection or erosion requires prompt assessment. Please telephone the rooms to discuss clinical urgency.
GP Referral Information →Specialist care
Dr Jack Crozier.
Urologist & Andrologist
FRACS (Urology)
Dr Crozier completed Australian specialist urology training, followed by fellowships at Princess Alexandra Hospital in Brisbane and University College London Hospitals.
His advanced training included reconstructive andrology and complex urological surgery. His public hospital work includes spinal injuries urology.
These areas are particularly relevant when continence surgery is complicated by previous radiation, urethral reconstruction, neurological bladder dysfunction or a previous implanted device.
Clinical considerations
- Post-prostatectomy stress incontinence
- Artificial urinary sphincter assessment
- Male sling suitability
- Previous pelvic radiation
- Complex urethral anatomy
- Previous continence surgery
- Neurogenic bladder and spinal cord injury
- Implant-related problems and revision assessment
The appropriate treatment and procedural arrangements are determined following individual assessment.
Common questions
Artificial urinary sphincter FAQs.
What is an artificial urinary sphincter?
An artificial urinary sphincter is an implanted device that helps reduce stress urinary leakage. It commonly includes an inflatable cuff, a scrotal pump and a pressure-regulating balloon.
Does an AUS cure all urinary incontinence?
No. It is primarily designed for sphincter-related stress incontinence. Urgency, overactive bladder and other urinary conditions may need different treatment.
Will I become completely dry?
Some men achieve very good continence, while others continue to use a security pad or experience some leakage. Complete dryness cannot be guaranteed.
How is the pump operated?
The pump is positioned beneath the scrotal skin. Once activated and healing is complete, the patient manually operates the pump to temporarily open the cuff for urination. Individual device instruction is provided by the treating team.
Is the AUS visible outside the body?
A traditional AUS is completely implanted. The scrotal pump can be felt through the skin, but there is normally no external device to wear.
Can I have an AUS after radical prostatectomy?
Yes. Persistent stress incontinence after prostatectomy is one of the main reasons AUS surgery is considered. Assessment is needed to determine whether leakage is caused by sphincter weakness and whether surgery is suitable.
Can I have an AUS after pelvic radiotherapy?
Previous radiation does not automatically exclude surgery. However, radiation can alter tissue quality and increase certain risks, particularly urethral erosion and future revision.
Is an artificial sphincter better than a male sling?
Neither is appropriate for every patient. AUS surgery is generally favoured for moderate-to-severe stress incontinence, while slings may be suitable for selected men with milder leakage.
How long after surgery is the AUS activated?
Activation commonly occurs after several weeks of healing, often around four to six weeks. The exact timing depends on the operation, wound healing and your surgeon's instructions.
Why am I still leaking immediately after surgery?
The device is generally left deactivated during initial healing, so leakage may continue until it is activated at a later appointment. Follow the instructions from your treating surgeon.
Is the AUS suitable if I have arthritis or poor hand function?
Adequate dexterity is important because the pump needs to be operated manually. Significant hand weakness, arthritis, reduced sensation or cognitive difficulties may make the device unsuitable or difficult to use.
Can an artificial sphincter wear out?
Yes. It is a mechanical implant and can malfunction over time. Changes in the surrounding urethral tissue can also affect continence. Revision or replacement may eventually be necessary.
What is urethral cuff erosion?
Erosion occurs when the cuff damages or enters the urethral wall. It is a serious complication that commonly requires device removal and treatment of the urethra.
What if I need a catheter in the future?
Tell all healthcare professionals that you have an AUS before urethral catheterisation. The device must be managed appropriately to reduce the risk of urethral injury. If catheterisation is required urgently, seek immediate medical assistance.
Can men with spinal cord injury have an AUS?
Selected patients with neurological sphincter weakness may be considered, but bladder pressure, compliance, emptying, catheterisation needs and hand function must be assessed. Improving continence should not compromise urinary-tract safety.
Can an AUS be replaced after infection or erosion?
Reimplantation may be possible in selected patients, but the urethra and surrounding tissues need reassessment. Further treatment may be required, and reimplantation is not always suitable.
Does the AUS affect erections or orgasm?
The operation is intended to improve urinary continence, not directly treat erections or orgasm. Sexual function may already have been affected by previous prostate treatment. Individual concerns should be discussed before surgery.
Can I have both an AUS and a penile implant?
Selected men with both stress incontinence and erectile dysfunction may undergo staged or combined reconstructive treatment. This requires individual planning, and patients must understand how to identify and operate the correct device.
How much does artificial sphincter surgery cost?
Costs depend on the hospital, device, surgery, anaesthesia and available insurance arrangements. A personalised written estimate should be obtained before proceeding.
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Southside Urology · Springwood
Still experiencing urinary leakage after prostate treatment?
Specialist continence assessment can help identify the cause of urinary leakage and determine whether further treatment may be appropriate.
This may include pelvic floor rehabilitation, male sling assessment, artificial urinary sphincter surgery or treatment of an associated bladder or urethral condition.
Southside Urology
Suite 7, 2 Murrajong Road
Springwood QLD 4127
Phone: 07 3106 0379
Referral fax: 07 3036 6621
Please advise reception if you have an existing artificial urinary sphincter or a history of complex urethral reconstruction.
Online appointment requests are not confirmed bookings and are not monitored for emergencies.
Medical information notice: This page provides general educational information about artificial urinary sphincter surgery. It does not replace individual medical assessment, informed consent or product-specific device instruction.
Device selection, availability, operation, expected outcomes and risks require individual discussion. No particular manufacturer or model is endorsed.