Artificial Urinary Sphincter: Regaining Control and Confidence
Learn how an artificial urinary sphincter can help manage urinary leakage, restore control, and improve confidence. Explore procedure, benefits, and recovery.
Written by Dr. Mohammed Kamran
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 29th Sep, 2025
Introduction
Living with complete urinary leakage can feel isolating and frustrating, impacting everything from your social life to your self-confidence. If you're a man experiencing significant urine loss, particularly after prostate surgery, you are not alone. This condition, known as stress urinary incontinence, is more common than you might think. While pads and protective garments can manage the symptoms, they don't address the root cause. For those seeking a long-term solution, the artificial urinary sphincter (AUS) is widely regarded as the gold-standard surgical treatment. This device offers a sophisticated and effective way to restore control and significantly improve quality of life. This guide will walk you through everything you need to know from how the device works and who it's for, to the details of the procedure, recovery, and what life looks like afterward. Our goal is to empower you with knowledge so you can have an informed discussion with your urologist about reclaiming your freedom. If you're struggling with severe leakage, consulting a specialist is the first step. You can consult a urology specialist online with Apollo24|7 to discuss your symptoms and explore if this treatment is right for you.
Understanding Urinary Incontinence: More Than Just a Leak
Urinary incontinence isn't just a minor inconvenience; it's a medical condition that can severely affect your emotional well-being. Understanding the specific type you have is crucial to finding the right treatment.
What is Stress Urinary Incontinence (SUI)?
Stress Urinary Incontinence (SUI) is the involuntary leakage of urine during physical activity that increases abdominal pressure. It's important to distinguish this from an overactive bladder. With SUI, you don't feel a sudden urge to urinate. Instead, leakage happens when you cough, sneeze, laugh, lift something heavy, or exercise. The problem lies in a weakened sphincter muscle, the ring-like muscle that keeps the urethra closed. When this muscle isn't strong enough to withstand pressure, urine escapes.
Common Causes of SUI in Men
The most common cause of SUI in men is damage to the sphincter muscle or the nerves that control it during surgery for prostate cancer or an enlarged prostate. A radical prostatectomy, while life-saving, can sometimes lead to post-prostatectomy incontinence. Other causes can include pelvic trauma, neurological conditions like spinal cord injuries, or the natural ageing process. The severity can range from a few drops to a complete loss of bladder control.
Consult a Urologist for the best advice
What is an Artificial Urinary Sphincter?
The artificial urinary sphincter is a remarkable implantable device designed to replicate the function of a healthy natural sphincter. It has been used successfully for decades and is considered the most effective solution for moderate to severe male SUI.
The Three Components: Cuff, Pump, and Balloon
The AUS is a sophisticated system made of three parts:
1. The Cuff: This is placed around the urethra. When filled with fluid, it gently squeezes the urethra closed, preventing urine leakage.
2. The Pump: This is placed in the scrotum, making it easily accessible. It contains a mechanism to transfer fluid.
3. The Balloon (Reservoir): This is placed in the abdomen and contains a reserve of sterile fluid. It provides the pressure needed to keep the cuff closed.
All components are connected by tiny tubes and are filled with a sterile saltwater solution.
How the AUS Mimics Your Natural Sphincter
The device works in a simple yet brilliant way. In its resting state, fluid is in the cuff, keeping the urethra closed and you continent. When you need to urinate, you gently squeeze and release the pump in your scrotum. This action moves the fluid from the cuff into the balloon reservoir, opening the urethra and allowing you to empty your bladder. After you finish, the fluid automatically flows back from the balloon to the cuff within 60-90 seconds, re-closing the urethra without any further action needed. This mimics the natural "open and close" function perfectly.
Are You a Candidate for an Artificial Urinary Sphincter?
Not everyone with incontinence is an ideal candidate for an AUS. A thorough evaluation by a urologist is essential.
Ideal Candidate Profile
The best candidates are typically:
- Men with moderate to severe stress urinary incontinence that hasn't improved with conservative treatments like pelvic floor exercises.
- Those who are in good overall health without active infections.
- Individuals who are motivated and capable of understanding and operating the device.
- Patients whose incontinence is primarily due to sphincter weakness (like after prostate surgery) rather than other bladder issues.
Important Pre-Procedure Evaluations
Before surgery, your urologist will conduct several tests to ensure the AUS surgery is appropriate. This may include a urodynamic study to assess how your bladder and urethra are functioning, a cystoscopy to look inside the urethra and bladder, and a urine test to rule out infection. These evaluations help create a successful treatment plan and manage expectations for the outcomes of urinary sphincter implants.
The AUS Implantation Procedure: What to Expect
Understanding the surgical process can help alleviate anxiety.
Step-by-Step Surgical Process
The implantation is performed under general or spinal anesthesia. The surgeon makes a few small incisions: one in the perineum (the area between the scrotum and anus) to place the cuff around the urethra, one in the scrotum for the pump, and one in the lower abdomen for the balloon reservoir. The components are connected, filled with fluid, and the incisions are closed. The entire surgery usually takes about one to two hours.
Anaesthesia and Hospital Stay
The procedure is typically done as an inpatient surgery, meaning you will likely stay in the hospital for one night for monitoring. Pain is managed effectively with medication. The device is left in a "deactivated" state initially to allow your body to heal around it.
Recovery and Rehabilitation: The Road to a New Normal
Patience is key during the AUS surgery recovery time. Healing properly is critical for the long-term success of the device.
The First Few Weeks: Healing and Restrictions
After surgery, you will have a catheter for a short period. You'll need to avoid strenuous activities, heavy lifting, and bicycling for about 6 weeks to allow the tissues to heal. Your doctor will provide specific instructions on wound care and activity restrictions.
The Big Moment: Activating Your AUS
Approximately 4 to 6 weeks after surgery, you will return to your urologist to have the device activated. This is a simple, in-office procedure where the doctor uses a special magnet to unlock the pump. They will then teach you how to use it. It may take a little practice to become comfortable with the technique.
Long-Term Care and Follow-ups
You will have regular follow-up appointments to ensure the device is working correctly. While the AUS is very durable, like any mechanical device, it may eventually require revision or replacement after many years (often 10+ years).
Potential Risks and Complications
As with any major surgery, it's important to be aware of potential risks.
Short-Term Surgical Risks
These include common surgical risks such as infection, bleeding, bruising, and temporary pain. There's also a small risk of injury to surrounding tissues. Your surgical team takes extensive precautions to minimise these risks.
Long-Term Device-Related Concerns
Over time, potential issues can include mechanical failure of the device, erosion (where the cuff wears through the urethral tissue), or infection that requires device removal. The risk of erosion is higher in patients who have had radiation therapy. Despite these risks, patient satisfaction rates with the AUS are consistently high, often over 90%.
Life with an Artificial Urinary Sphincter
For most men, the AUS is life-changing.
Mastering the Technique: How to Use the Device
Using the device becomes second nature with practice. You will typically need to use the pump to urinate every 4-6 hours. The automatic re-closing feature means you don't have to worry about leakage throughout the day.
Impact on Daily Activities and Intimacy
Most men can return to all their normal activities, including exercise and sports. The device is not noticeable to others. For intimacy, the device generally does not interfere with erectile function. It's important to communicate with your partner, and your doctor can provide guidance specific to your situation.
Alternatives to the Artificial Urinary Sphincter
The AUS is not the only option. The choice often depends on the severity of leakage.
The Male Sling Procedure
This is a less invasive surgery where a synthetic mesh is used to support the urethra. It's often more effective for men with mild to moderate incontinence. The artificial urinary sphincter vs male sling decision is a key discussion to have with your urologist.
Bulking Agents and Other Options
Urethral bulking agents involve injecting a material around the urethra to add bulk and help it close better. This is typically for very mild cases and may need to be repeated. Non-surgical options include continued pelvic floor physiotherapy and the use of external occlusion devices or penile clamps.
Making the Decision: Key Questions to Ask Your Doctor
Before moving forward, be prepared. Ask your doctor:
- Based on my specific condition, what are my realistic expectations for dryness?
- How many of these procedures do you perform each year?
- What is your rate of complications like infection or erosion?
- What is the typical recovery process like for your patients?
- What happens if the device fails years from now?
Conclusion
Dealing with complete urinary leakage can make you feel like you've lost control over a fundamental part of your life. However, modern medical advancements like the artificial urinary sphincter offer a powerful path to regaining that control. This proven treatment can dramatically reduce or eliminate leakage, allowing you to confidently re-engage with the activities and people you love without the constant worry of accidents. While the decision to undergo surgery is significant, being armed with comprehensive knowledge allows you to partner effectively with your healthcare provider. If you are struggling with severe incontinence, don't hesitate to seek expert advice.
Consult a Urologist for the best advice
Consult a Urologist for the best advice
Dr Anupam Sharma
Urologist
18 Years • MBBS, MS(Gen Surgery), DNB (Urology)
Delhi
Apollo Hospitals Indraprastha, Delhi
Dr Karthik Maripeddi
Urologist
13 Years • MBBS MS FMAS MCh URO(OSM)
Hyderguda
Apollo Hospitals Hyderguda, Hyderguda
Dr Anil Kumar T
Urologist
12 Years • MBBS, MS ( General Surgery ) , MCh (Genito-Urinary Surgery , CMC Vellore) , Fellowship in Minimally Access Surgery , Fellow- ship in Uro-Oncology and Robotic Surgery, UICC Fellowship (Geneva, Switzerland).
Bengaluru
Apollo Hospitals Jayanagar, Bengaluru
Dr. Moin Mohammed Bavakatti
Urologist
13 Years • MBBS, MS (General Surgery), Mch (Urology), DNB (Urology), Diploma in Minimal Access Surgery, Fellow of Internal College of Robotic Surgeons), Vinci Surgical system, Fellow in Endocrinology, Clinical and Research fellow in Laparoscopic Urology, Laser Endourology & Laparoscopic & Robotic Urology, Fellowship in 3D laparoscopic Urology
Bengaluru
Dr Moin Mohammed Bhavikatti Clinic, Bengaluru
Dr. Kunal Kumar Mehar
Urologist
10 Years • Mbbs, Ms, Mch
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
Consult a Urologist for the best advice
Dr Anupam Sharma
Urologist
18 Years • MBBS, MS(Gen Surgery), DNB (Urology)
Delhi
Apollo Hospitals Indraprastha, Delhi
Dr Karthik Maripeddi
Urologist
13 Years • MBBS MS FMAS MCh URO(OSM)
Hyderguda
Apollo Hospitals Hyderguda, Hyderguda
Dr Anil Kumar T
Urologist
12 Years • MBBS, MS ( General Surgery ) , MCh (Genito-Urinary Surgery , CMC Vellore) , Fellowship in Minimally Access Surgery , Fellow- ship in Uro-Oncology and Robotic Surgery, UICC Fellowship (Geneva, Switzerland).
Bengaluru
Apollo Hospitals Jayanagar, Bengaluru
Dr. Moin Mohammed Bavakatti
Urologist
13 Years • MBBS, MS (General Surgery), Mch (Urology), DNB (Urology), Diploma in Minimal Access Surgery, Fellow of Internal College of Robotic Surgeons), Vinci Surgical system, Fellow in Endocrinology, Clinical and Research fellow in Laparoscopic Urology, Laser Endourology & Laparoscopic & Robotic Urology, Fellowship in 3D laparoscopic Urology
Bengaluru
Dr Moin Mohammed Bhavikatti Clinic, Bengaluru
Dr. Kunal Kumar Mehar
Urologist
10 Years • Mbbs, Ms, Mch
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
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Frequently Asked Questions
How long does an artificial urinary sphincter last?
The AUS is a durable device, but it is mechanical and can wear out over time. Studies show that the device has a longevity of about 10-15 years for a majority of patients, though some may last longer and others may require revision surgery sooner due to mechanical failure or other complications.
Will the device be noticeable to other people?
No. The device is entirely internal and cannot be seen. The pump is located in the scrotum and may be felt as a small, firm lump, similar to a testicular implant, but it is not visible to others.
Can I have an MRI if I have an artificial urinary sphincter?
This is a critical question. Most modern AUS devices are MRI-conditional, meaning you can safely undergo an MRI under specific conditions (e.g., a certain strength of an MRI machine). You must always inform your radiologist and MRI technician that you have an AUS implant before any scan.
What happens if the device fails?
If the device fails mechanically or due to an issue like erosion, revision surgery is possible. This involves replacing the malfunctioning component or the entire device. Revision surgery is generally successful, though it can be more complex than the initial implantation.
Is artificial urinary sphincter surgery painful?
You will be under anaesthesia during the surgery and will not feel pain. Post-surgery, you can expect some pain, discomfort, and swelling in the incision areas, which is effectively managed with pain medication prescribed by your doctor. This discomfort typically subsides within a week or two.