In which patient would an artificial urinary sphincter be most appropriate?

• A. Men with severe post-prostatectomy incontinence due to intrinsic sphincter deficiency.
• B. Women with urge incontinence.
• C. Children with enuresis.
• D. Men with nocturnal enuresis only.

Answer: (A)

An artificial urinary sphincter is most appropriate for men with severe stress incontinence due to intrinsic sphincter deficiency, particularly after prostate surgery. In this situation the external urethral sphincter has been damaged or weakened, so leakage occurs with minimal pressure. The artificial sphincter mechanically restores continence by placing a cuff around the urethra that stays closed to prevent leakage and can be deflated on demand using a pump to allow urination, with a reservoir system to maintain pressure. This device provides a reliable, durable solution for significant leakage that hasn’t responded to conservative measures, making it the best option for this patient group.

Urge incontinence, by contrast, stems from detrusor overactivity and is treated with bladder-focused therapies such as antimuscarinics, beta-3 agonists, bladder training, or neuromodulation, not an urethral cuff.

In children with enuresis, the issue is typically immature bladder control and is managed with alarms, conditioning, or medications like desmopressin, not an implanted continence device.

Nocturnal enuresis in men, when it occurs in isolation, usually has other contributing factors and is addressed differently rather than with an artificial sphincter.

Thus, the scenario described—severe post-prostatectomy incontinence due to intrinsic sphincter deficiency—fits best with an artificial urinary sphincter.