Introduction: The Artificial Urethral Sphincter (AUS) is the gold standard for stress urinary incontinence (SUI). The AMS 800 AUS is the most widely used device and has well over a 30-year track record of excellent efficacy and durability. We describe tips for AUS placement and advanced troubleshooting for when you run into problems.
Methods: Proper placement of an AUS requires no bulbospongiosus muscle on the urethra. We utilize a split and roll to ensure a 2cm plane for the AUS. Prior to pump placement we cycle the AUS pump 5-10x for easier activation. We create a “Fuse Box” for future troubleshooting. in cases of mis-sizing an AUS cuff, we modify our cuff via a incision into the cuff and a carefully placed 4-0 prolene. Our technique for troubleshooting an AUS starts with assessing for pressure regulating balloon (PRB) fatigue.
Results: Use of our techniques has resulted in an excellent success record for AUS placement. Use of our cuff modification technique has shown no difference in survival or adverse events as a result of the modification.
Conclusions: A properly placed and sized AUS is the gold standard for SUI. Principles for a successful placement of an AUS includes use of the Split and Roll technique, cycling the pump 5-10x prior to placement, creation of
a “Fuse Box,” and salvaging an improperly sized cuff through use of our modification technique. During troubleshooting always check the PRB first.