STOFFEL and BARRETT © 2008 THE AUTHORS 644 JOURNAL COMPILATION © 2 0 0 8 B J U I N T E R N A T I O N A L | 1 0 2 , 6 4 4 – 6 5 8 | doi:10.1111/j.1464-410X.2008.07872.x Surgery Illustrated – Surgical Atlas The artificial genitourinary sphincter John T. Stoffel and David M. Barrett Department of Urology, Lahey Clinic Medical Center, Burlington, USA Accepted for publication 2008 ILLUSTRATIONS by STEPHAN SPITZER, www.spitzer-illustration.com INTRODUCTION Since its introduction by Scott in 1973, the artificial genitourinary sphincter (AUS) has proven to be an effective treatment for refractory urinary incontinence [1]. Over the years, the original AUS 721 model had many revisions to the cuff, pump and reservoir components. The most current development, the narrow back-cuff AMS 800 (American Medical Systems, Minnetonka, MN, USA), has reported continence rates of 61–96% and with low morbidity [2,3]. In this article describing the implantation of the AMS 800 AUS, our goal is to outline proper patient selection, define current surgical technique, and identify troublesome postoperative care issues. PLANNING AND PREPARATION The checklist for the AMS 800 is: Before surgery • Stable symptoms for > 6 months; stress incontinence much greater than urge incontinence symptoms; • Normal perineal/scrotal examination; • Negative urine culture; • Radiological or cystoscopic evidence of a patent urethra; Surgery • Perioperative antibiotics (ampicillin/ gentamicin); • AMS 800 components; • Cuffs (3.5–4.5 cm bulbar, 8–14 cm bladder neck); • Control pump; • Balloon reservoir (51–60, 61–70, 71–80, 81–90 cmH 2 O); BJUI BJU INTERNATIONAL