From hydraulics to electronics: prosthetic urology enters the digital era

For several decades, innovation in prosthetic urology was mainly mechanical: better materials, a lower risk of infection, more reliable hydraulic components and devices that are easier for patients to use. But another evolution is now starting to appear. At ESGURS–ESAU26, held in Ghent on 24 and 25 September, it was particularly noticeable: urological prostheses are gradually becoming more adaptive, more technological and, perhaps in the future, more intelligent.

The European congress of specialists in reconstructive surgery and andrology gave considerable attention to penile implants, artificial urinary sphincters and new reconstructive technologies. Prosthetic surgery obviously remains based on robust mechanical principles, but the way these devices are evolving points to a much broader transition.

A model that changed little for decades

The artificial urinary sphincter is probably the best example.

For several decades, its principle has relied on a relatively simple design: a cuff placed around the urethra applies enough pressure to maintain continence. When the patient wants to urinate, he manually operates a pump that temporarily deflates the cuff.

This hydraulic principle has proven its worth. Successive improvements mainly concerned the reliability of the materials, ease of implantation and the reduction of complications.

But the system keeps one fundamental characteristic: the pressure applied to the urethra is relatively standardised, whereas the patient's real life is not.

Abdominal pressure is not the same when a patient is sleeping, walking, coughing, climbing stairs or exercising. Yet a conventional sphincter does not “know” what its wearer is doing.

This is precisely where some new generations of devices are now trying to make progress.

Towards more adaptive pressure

Current developments are no longer only about refining a pump or a cuff. The ambition is increasingly to create devices that can better adapt to the patient's physiological needs.

Adaptive-pressure systems are beginning to change the way we think about the artificial sphincter. Other electromechanical solutions are also in clinical development.

This change in philosophy is important.

Until now, we essentially implanted a mechanical device whose behaviour was defined when it was designed. With electronics, it becomes theoretically possible to modify, programme or adjust certain parameters after implantation.

This kind of evolution could have concrete consequences: seeking a better balance between continence and tissue protection, adapting treatment to different patient profiles, or changing certain settings without automatically requiring another operation.

Not all of these possibilities are available in routine clinical practice yet, of course. Some remain experimental. But the technological direction is clear.

Penile implants could follow the same path

This transformation is not limited to incontinence.

Today's hydraulic penile implants are also remarkably mechanical. Their effectiveness rests precisely on this simplicity and on decades of technical improvement.

Yet concepts for electromechanical prostheses are also beginning to emerge.

The potential benefit would not simply be replacing a manual pump with an electronic button. In time, electronics could make it possible to completely rethink the interface between patients and their devices: simpler activation, programmable settings, technical monitoring or earlier detection of certain malfunctions.

This raises a particular question: what will happen when these implants start generating data?

And tomorrow, artificial intelligence?

This is probably where the boundary between prosthetics and digital medicine becomes particularly interesting.

An implant equipped with sensors could theoretically measure various parameters: pressure, frequency of use, device behaviour or unusual mechanical events.

The next step could be the use of algorithms able to interpret this information.

In the longer term, one can imagine a sphincter that adapts certain settings to the patient's activity profile, or a device that detects an unusual change in its own functioning before the patient even notices the consequences.

We are not there yet.

It would therefore be incorrect today to speak of sphincters or penile implants “driven by artificial intelligence” in everyday clinical practice. But the technological trajectory is becoming interesting: mechanical → hydraulic → electronic → potentially algorithmic.

The surgeon will remain central

This evolution should not give the impression that technology will replace surgery.

In prosthetic urology, the outcome still depends enormously on patient selection, the indication, the surgeon's experience, the surgical technique and follow-up.

Even a highly sophisticated implant will never make up for a poor indication.

But the device could gradually become a more active partner in treatment, able not only to restore a function but also to adapt better to its user.

After several decades spent perfecting the mechanics, prosthetic urology may therefore be on the threshold of a new stage: that of the connected, adaptable and perhaps, in time, intelligent implant.

References

European Association of Urology. ESGURS–ESAU26 scientific programme interview with Prof. David Ralph. https://uroweb.org/news/esgurs-esau26-scientific-programme-interview-with-prof-david-ralph

This article was first published in French and Dutch on 3 November 2026 on Numerikare.be.