Editorial
Written byMen's Health Istanbul Editorial Team
Medical reviewer (awaiting sign-off)Asst. Prof. Dr. Yusuf İlker Çömez
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The short answer
An artificial urinary sphincter is a small, fluid-filled device implanted during surgery to treat stress urinary incontinence in men, most often leakage that continues after prostate cancer surgery. It has three parts: a soft cuff around the urethra, a pump in the scrotum and a pressure-regulating balloon in the lower abdomen. The cuff gently squeezes the urethra closed to stop leaks. To pass urine, the man squeezes the pump, the cuff opens for a few minutes and then closes again by itself. It is usually considered when leakage is significant and has not improved with time and pelvic floor exercises.
Key takeaways
- An artificial urinary sphincter treats stress incontinence in men, most often after prostate cancer surgery.
- A cuff keeps the urethra closed; squeezing a pump in the scrotum opens it to pass urine, and it then closes on its own.
- It is usually considered after leakage has had time to improve and pelvic floor exercises have been tried.
- Men with the device must tell any doctor before a urinary catheter or camera test is used.
Why do some men leak urine after prostate surgery?
Men have muscles around the urethra (the tube that carries urine out of the body) that stay tightened to keep urine in. The prostate sits right next to these muscles. When the prostate is removed for cancer, the muscle that remains may be weakened, at least for a while. The result is often stress urinary incontinence: leaking when coughing, sneezing, lifting, standing up or exercising.
This is common and often improves. The ProtecT trial, a large UK study of men with localised prostate cancer, found that surgery had a greater effect on urinary continence than radiotherapy or monitoring, with some recovery over time. For a smaller group of men, significant leakage continues.
What is an artificial urinary sphincter?
An artificial urinary sphincter (AUS) is an implanted device that takes over the job of the weakened muscle. Like a three-piece penile implant, it runs on sterile fluid and the man's own hand, with no batteries or electronics. It has three connected parts:
- A cuff that wraps around the urethra, under the skin behind the scrotum. When full of fluid, it gently squeezes the urethra closed.
- A pump that sits in the scrotum, where it can be felt and squeezed.
- A pressure-regulating balloon placed in the lower abdomen, which keeps the cuff at a steady pressure.
How does an artificial urinary sphincter work day to day?
Most of the time the cuff is closed, so urine stays in the bladder. When the man wants to pass urine, he squeezes the pump a few times. This moves fluid out of the cuff and into the balloon, the urethra opens and he can empty his bladder normally. Over the next few minutes, fluid flows back into the cuff by itself and the urethra closes again.
After the operation, the device is usually left switched off for several weeks while the tissues heal. The team then activates it in clinic and shows the man how to use it.
Who is an artificial urinary sphincter for?
European guidelines describe the AUS as an established option for men with moderate to severe stress incontinence, particularly after prostate surgery. It is usually considered when:
- enough time has passed after surgery for natural improvement to have happened;
- pelvic floor muscle training, ideally with specialist guidance, has been tried;
- the leakage has a real effect on daily life.
The man also needs to be able to find and squeeze the pump, and to remember to use it. Tests of bladder function are often done beforehand. For milder leakage, a male sling, a simpler operation with no pump, may be discussed instead.
What are the risks of an artificial urinary sphincter?
As with any implant, infection is the main concern and usually means the device has to be removed. Other possible problems include the cuff wearing into the urethra (erosion), the tissue under the cuff thinning over time so that leaks return, and mechanical failure. Some men need a further operation at some point. Men who have had radiotherapy may face a higher chance of complications, which is something to discuss openly with the surgeon.
What should other doctors know?
This is important. Before any doctor or nurse passes a urinary catheter or a camera into the urethra, the cuff must be opened. Men with an AUS are usually given a device card to carry and should mention it before any operation or hospital admission.
When to see a doctor
If you are still leaking urine months after prostate surgery, or leakage is affecting work, exercise or sleep, it is worth raising with a urologist rather than simply putting up with pads. There is often more that can be done than men expect.
Questions men also ask
Is leaking urine after prostate surgery normal?
Some leakage is common after the prostate is removed, and many men improve over the following months. Large studies such as the ProtecT trial found that surgery affected continence more than other options, with some recovery over time.
Do I need to carry a card after an artificial sphincter?
Men are usually advised to carry a device card, because the cuff must be opened before anyone passes a urinary catheter or camera through the urethra.
Does an artificial urinary sphincter affect erections?
The sphincter controls urine flow, not erections. Erectile difficulties after prostate surgery are a separate issue that can be assessed and treated in their own right.
Sources & further reading
- EAU EAU Guidelines on Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS) (opens in a new tab) (2024) European Association of Urology
- EAU EAU Guidelines on Prostate Cancer (opens in a new tab) (2024) European Association of Urology
- New England Journal of Medicine Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer (opens in a new tab) (2016) Donovan JL, et al.
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This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.
