Stress urinary incontinence — leaking with coughing, lifting, or standing up — is the most common lasting complication after prostate surgery. Many men are told to accept it. In most cases it can be corrected surgically, with high satisfaction.
Why it happens
Continence in men depends largely on the external urinary sphincter. Radical prostatectomy removes the prostate, which sits directly above that sphincter, and radiation can impair its function. When the sphincter cannot fully close, physical stress transmits pressure to the bladder and urine escapes.
Most men improve substantially in the first 6–12 months after surgery with pelvic floor therapy. Leakage that persists beyond about 12 months is unlikely to resolve on its own, and that is the point at which surgical treatment is usually considered.
The two main operations
| Male sling | Artificial urinary sphincter (AUS) | |
|---|---|---|
| Best suited to | Mild to moderate leakage | Moderate to severe leakage; the standard for significant incontinence |
| How it works | A mesh sling repositions and supports the urethra | An implanted cuff around the urethra holds it closed; you open it with a pump to urinate |
| Patient action needed | None — passive | Squeeze the scrotal pump before each void |
| After radiation | Less reliable | Preferred option |
| Durability | Good in appropriately selected patients | High satisfaction; revision may be needed over many years |
The artificial urinary sphincter
The AUS has been the reference standard for significant male stress incontinence for decades. It has three components, all internal:
- A cuff around the urethra, which is normally filled and keeps the urethra closed
- A pump in the scrotum
- A pressure-regulating balloon in the abdomen
To urinate, you squeeze the pump; fluid moves out of the cuff, the urethra opens, and you void normally. The cuff refills automatically over the next few minutes and continence is restored without any further action.
What results look like
Published series consistently report high satisfaction — most men go from multiple pads per day to no pads or a single security pad. It is worth being clear that "socially dry" rather than absolutely dry is the usual and expected outcome, and that an AUS is a mechanical device: over a span of many years, some men require a revision or component replacement. Those trade-offs are well understood, and satisfaction remains high in spite of them.
Recovery and use
- Surgery is usually outpatient or one overnight
- The device is left deactivated for roughly six weeks so tissues heal before any pressure is applied
- Activation happens at an office visit, where you are taught to use the pump — this is when continence begins
- Heavy lifting and cycling are restricted during the healing period
- Important, lifelong: carry a device card and tell any clinician before catheterization — a catheter placed without deactivating the cuff can injure the urethra
Common questions
How long should I wait after prostate surgery before treating incontinence?
Generally about 12 months. Most men improve considerably during the first 6–12 months with time and pelvic floor therapy. Leakage that persists past a year is unlikely to resolve spontaneously, and surgical treatment is typically considered at that point.
Should I have a sling or an artificial urinary sphincter?
It depends chiefly on severity. Slings work well for mild to moderate leakage. The artificial urinary sphincter is the standard for moderate to severe incontinence and is preferred after radiation. The number of pads you use per day, along with testing, guides the recommendation.
Does the artificial urinary sphincter work?
It has been the reference standard for decades. Most men go from multiple pads daily to no pads or a single security pad, and satisfaction in published series is high. Complete dryness is not guaranteed — 'socially dry' is the usual and expected result.
Will people see the device?
No. All three components are internal. The pump sits in the scrotum, where it can be felt but is not visible.
How long does an artificial urinary sphincter last?
It is a mechanical device implanted in the body, so it may eventually require revision or component replacement. Many function well for a decade or more, and revision surgery is a routine part of long-term care rather than a failure of the concept.
Is it hard to use?
No. You squeeze the pump in the scrotum before urinating; the cuff opens, you void, and it refills on its own within a few minutes. Most men become comfortable with it quickly.
What happens if I need a catheter later?
Always tell the clinician that you have an artificial urinary sphincter and carry your device card. The cuff must be deactivated before a catheter is placed, otherwise the urethra can be seriously injured.
Related procedures
Discuss your options with Dr. Azad
Referrals are welcome but not required. Bring any records from prior procedures — operative notes, imaging, or urethrograms — and we will review them together.
504-988-5271Dr. Babak Azad — Reconstructive Urology, Metairie & New Orleans, LA