Artificial urinary sphincters in males and females and neurogenic patients, techniques, and indications

The introduction of the artificial urinary sphincter (AUS) in 1972 was heralded as a revolution for the treatment of stress incontinence (Scott et al., 1973). The evolution of the AUS has affected the current surgical options for urinary incontinence. With its unique features, the AUS has been an attractive option for the treatment of urinary incontinence regardless of gender. The device has evolved in the last decades and has now been in routine clinical use for nearly 50 years (Burkhard et al., 2019). Furthermore, the indications and surgical principles involved in its use along with short- and long-term outcomes are more clearly defined. The main indications for AUS insertion are post-prostatectomy incontinence (PPI), sphincter weakness incontinence due to neurogenic bladder dysfunction, intrinsic sphincter deficiency (ISD) and rare congenital causes of incontinence. In the following we summarize the conclusions worked out during the expert workshop on artificial urinary sphincter during ICS 2022 in Vienna, Austria; and present some strategies for difficult cases.