Artificial Urinary Sphincter Melbourne
The artificial urinary sphincter (AUS) is considered the gold-standard surgical treatment for moderate to severe male stress urinary incontinence. It is a hydraulic device that mimics the function of the natural urinary sphincter, providing continence by compressing the urethra and allowing voluntary voiding when activated. The most commonly used device is the AMS 800, which has been successfully implanted for over 40 years. The AUS is particularly effective for men with significant incontinence after radical prostatectomy, and offers excellent long-term continence outcomes.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Gold-standard treatment with highest success rates for severe incontinence
- 90-95% of men achieve social continence (0-1 pad per day)
- Allows normal voluntary voiding without catheterisation
- Long-lasting results - average device lifespan 7-10 years
- Can be revised or replaced if needed
- Dramatically improves quality of life
The Procedure
The AUS consists of three components: a cuff placed around the urethra, a pressure-regulating balloon placed in the abdomen, and a control pump placed in the scrotum. Surgery is performed under general anaesthesia through incisions in the perineum and lower abdomen. The cuff keeps the urethra closed at rest, maintaining continence. To urinate, the patient squeezes the scrotal pump several times, transferring fluid from the cuff to the balloon and opening the urethra. The cuff automatically refills after 2-3 minutes, restoring continence. The device is left deactivated for 6 weeks after surgery to allow healing.
Who Is a Candidate?
AUS is recommended for men with moderate to severe stress urinary incontinence (typically using 3+ pads per day), intrinsic sphincter deficiency after prostate surgery, incontinence persisting at least 12 months after prostatectomy, those who have failed or are not suitable for male sling, and men with adequate manual dexterity to operate the pump. Relative contraindications include untreated bladder dysfunction, recurrent urinary infections, uncontrolled diabetes, and inability to operate the device. Preoperative assessment includes urodynamics and cystoscopy.
Recovery
Hospital stay is typically 1-2 nights. A catheter remains for 1-2 days. The device is implanted in the deactivated (open) position and remains so for 6 weeks to allow healing - during this time incontinence continues unchanged. At 6 weeks, the device is activated in the clinic (a simple process taking minutes). Avoid cycling and straddling activities for 3 months. Most men notice dramatic improvement immediately upon activation. Regular follow-up monitors device function.
Risks & Considerations
AUS risks include infection requiring device removal (2-5%), mechanical failure requiring revision (10-20% over 10 years), urethral erosion or atrophy requiring revision, bleeding or haematoma, device malfunction, and the need for eventual device replacement due to wear. Men with previous radiation have higher complication rates. Patients must be willing and able to operate the device and attend regular follow-up. Despite these considerations, patient satisfaction with AUS is very high due to the significant improvement in quality of life.