Status, Application and Future Directions of Artificial Urinary Sphincters

Dear Colleagues,

For decades, the artificial urinary sphincter (AUS) has been the standard surgical treatment for severe male stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency (ISD). Interestingly, the AUS, first developed in the 1970s, was originally designed for female SUI patients but achieved its greatest success when applied to male patients experiencing incontinence after radical prostatectomy. Subsequent advancements in surgical techniques have further improved AUS outcomes and accessibility. Notably, robot-assisted AUS implantation in female patients has emerged as a new alternative for those with severe ISD, demonstrating lower complication and morbidity rates and higher continence success compared to traditional open surgery.

One of the primary drawbacks of AUS therapy is the risk of complications and device malfunctions. Well-documented issues include urethral cuff erosion, infection, and device malfunctions such as pump or balloon failures. These complications often necessitate revision surgeries and can adversely affect long-term patient outcomes.

Despite these challenges, the AUS offers unique advantages over other treatment modalities, particularly in complex patient populations. It is the only anti-incontinence procedure that can restore both normal storage and voiding functions by increasing outlet resistance during rest when the cuff is closed and maintaining low outlet resistance during the voiding phase when the cuff is open. For patients with a history of bladder outlet surgeries who have not achieved sufficient relief with slings or bulking agents, the AUS provides reliable incontinence control while allowing normal voiding. Ongoing research and development are expected to further advance AUS therapy. Next-generation electronically controlled 'smart' AUS devices are currently under investigation, suggesting the potential for this long-standing treatment to evolve into a more effective and durable solution.

In this Special Issue, we invite authors to submit papers on topics such as robot-assisted AUS implantation in female patients or those with neurogenic incontinence, management of AUS complications, reviews of device malfunctions, development of next-generation AUS devices, and historical reviews of AUS advancements.

Dr. JiSung Shim
Guest Editor

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• ISD
• robot surgery
• neurogenic SUI
• female AUS
• complication
• erosion
• urethroplasty
• malfunction
• PPI
• BOO