Treating male urinary incontinence using the artificial urinary sphincter

March 26, 2024

Prostate cancer and benign growth of the prostate are two very common conditions affecting thousands of men every year. Surgeons perform thousands of surgeries to treat these conditions.

Unfortunately, because of many different factors, stress urinary incontinence (SUI) can result. SUI is a condition in which urine leaks during activities such as walking and lifting or when coughing. SUI often requires men to wear multiple pads or even heavy adult diapers during the day to avoid urine leaking. Men with SUI often experience depression, social withdrawal, feelings of isolation and embarrassment.

The artificial urinary sphincter (AUS) was introduced in 1972 as the gold standard for dealing with this issue. Despite the AUS being available for more than 50 years, many physicians and patients do not know it exists. Also, many practicing urologists have not received sufficient training in the evaluation and implantation of the AUS. In fact, most graduating urology residents perform only four AUS procedures during their residency training, according to findings of a 2013 study by Lai and colleagues published in The Journal of Urology.

The AUS implantation is a simple surgery that typically involves either an outpatient procedure or a single overnight hospital stay. However, from the surgeon's perspective, this procedure requires a significant amount of experience to complete correctly, to reduce complications and to produce the best long-term results for the patient.

In contrast to typical surgeon experience, the learning curve for the AUS surgery appears to be very long and without a clear plateau, which can lead to unwanted reoperations as cited in a 2011 study by Sandhu and colleagues published in European Urology. This means the surgeon's experience with AUS implantation matters to help reduce and avoid complications. According to the results of the study, a surgeon needs to perform at least 200 AUS procedures to ensure the best patient outcomes. This is especially important since every patient being considered for an AUS has already had a complication following prostate surgery and is thus in tune with complications and most likely wary of an additional surgery.

Since 1972, Mayo Clinic in Rochester, Minnesota, has been at the forefront of the surgical implantation of the AUS, with implant volumes increasing each year. To date, Mayo Clinic researchers have published over 100 articles specifically dedicated to evaluation, treatment and results with the AUS device to lower complications, improve long-term results and ensure the best possible outcomes for men with urinary incontinence.

Mayo Clinic has the world's largest databank of AUS patients (> 3,000) and its physicians have implanted more AUS devices than any other institution worldwide. Daniel S. Elliott, M.D., a urologist at Mayo Clinic in Rochester, Minnesota, has performed more than 2,000 AUS procedures in his career to date, which is the largest number performed by a single surgeon in the United States.

The surgeon's experience is only one factor in improving patient outcomes — it takes a multidisciplinary effort that involves a dedicated surgical team in the operating room, nurses on the hospital floor for postoperative care and nurses in the clinic who all have vast experience dealing with the AUS. This team approach plays a role in minimizing risk and improving outcomes.