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Artificial urinary sphincter (AUS) is the gold standard of intervention for male stress incontinence. It is a proven and effective treatment for mild to severe incontinence. A ring called a cuff is wrapped around the urethra to provide extra pressure to hold in urine.

kansashealthsystem.com - Male Incontinence Solutions | The University of Kansas Health System

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This particular patient that had his surgery today was a patient who had undergone a radical prostatectomy for prostate cancer. His prostate cancer was cured, but he was left with one of the unfortunate side effects that happen in a low percentage of people, and that is urinary incontinence.

He presented today to get an artificial urinary sphincter in place.

The prostate actually lies right next to what we call the genitourinary sphincter, which is the muscle that you use to control your urine. So, sometimes after a prostatectomy or a prostate removal you can actually have an injury to that muscle, where patients start to lose control. That can be variable, from just a little bit of leakage to really quite dramatic leakage with someone using anywhere from eight to 10 pads a day.

The incontinence that occurs is usually called stress incontinence.

This occurs when people are doing heavy activity.

They're lifting.

They're playing golf.

They're doing kind of the things in their day-to-day living.

Simply getting out of a chair can cause a leakage, so it can be quite debilitating. It's difficult to go out to dinner if you're worried about having wet pants, changing multiple pads per day. Car trips are often difficult or leaving the house for long periods of time. It can really change someone's life. Basically, what we do is we make a small incision in the perineum, which is the space in between the legs, to locate the urethra or the tube that you pee through. So, what we're looking at here is we've split the fat layer over top of the urethra, and we're just now getting into the muscle that surrounds the urethra. Last loop. So, what we've essentially done here to start the case is we've made an incision through the perineum and dissected down through the subcutaneous fat. We've spread open the bulbospongiosus muscle, which is the muscle used for ejaculatory function, to expose the urethra, which is this blue midline structure, which we also have the blue tape wrapped around.

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This is the area where our artificial sphincter is gonna go and where we specifically size it and custom fit it to the patient's needs in terms of their degree of incontinence. So, this is the cuff that we're going to place here in the patient. This will provide the pressure support to help hold the urethra closed. Here you can see the cuff being put into place. We're just going to deploy this. This is what the device looks like. You can see here the inflatable cuff is around. There's tubing that we're gonna pass into the abdomen, so the patient can activate the device, but this is essentially gonna provide coaptation of the urethra in order for him to help maintain his continence. What we're going to do now is just pack the wound with an antibiotic soaked sponge and then proceed to the abdominal portion of the operation. All right. What we've basically done here is we've made a series of sharp incisions down to the muscle layer of the abdominal wall. We're then entering the extraperitoneal space, which is the space outside the sac that holds the intestines and the bladder.

We're just adjacent to the bladder.

We'll be putting the reservoir, which holds the fluid, in order to make the device function.

Again, same with the other incision.

We copiously irrigate this in order to prevent an infection.

What we have here is his device comes from ... this black and clear tubing comes from the reservoir.

This yellow tubing comes from the cuff.

We have a retractor or ring forceps in the scrotum right now, which is marking where we're gonna put our pump to. So, we'll place this device, and then we'll make the connections. Here you can see the device has been implanted into the scrotum.

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The pump has been subcutaneously tunneled down into the scrotum.

This is what the patient will manipulate in order to use the restroom. All right. Now, what you can see here is we've made the connections and trimmed the tubing down, so it's an appropriate length.

We're going to release these connections and bury the tubing.

We'll pull the pump down into its appropriate spot within the scrotum, which you can see here, and the tubing disappears.

We'll then begin to close our incisions.

What we did today is we placed a small cuff around that urethra and then hooked it up to a device that goes into the scrotum, which we refer to as the pump. So, when the patient needs to urinate, he simply squeezes that pump, releases the cuff around the urethra. He's able to urinate. The device then resets, and he can go about his normal daily affairs, hopefully dry. This is an example of the device. Here we have a reservoir, which goes into the patient's abdomen.

This stores the fluid to help make the device function.

What I've illustrated here with this red catheter is the urethra or the peeing tube, if you will.

We have a cuff or a balloon which goes around that.

By this device squeezing, this is what's gonna help provide the patient continence. When the patient needs to urinate, this pump has been tunneled into his scrotum, in which case he just simply squeezes the base of this.