Artificial Urinary Sphincter
For significant incontinence persisting after prostate surgery, a device operation in which a cuff around the urethra and a pump in the scrotum restore control.
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 60–120 minutes
- Anesthesia
- General or spinal anaesthesia
- Hospital stay
- 1–2 nights
- Stay in Türkiye
- 10–14 days
- Catheter duration
- 1 day
- Return to work
- 2–4 weeks (desk work), 6 weeks (heavy work)
- Flight clearance
- After the review appointment
About the condition
Some men leak urine after surgery for prostate cancer (radical prostatectomy). In most, the problem lessens markedly over months. In a group of patients, however, leakage persists despite pelvic floor exercises and time, and seriously restricts daily life. The artificial urinary sphincter was developed for that group.
The device has three parts: a CUFF placed around the urethra, a FLUID RESERVOIR placed inside the abdomen, and a PUMP sitting under the skin of the scrotum. Normally the cuff is inflated and keeps the urethra closed. When you want to pass urine you squeeze the pump in the scrotum a few times; fluid moves from the cuff to the reservoir, the channel opens and you void. Within a few minutes the fluid returns to the cuff by itself and the channel closes again.
THIS IS A TREATMENT THAT REQUIRES THE PATIENT TO OPERATE THE DEVICE. You must use the pump every time you pass urine. Manual dexterity, eyesight and cognition are therefore assessed. Implanting the device in someone who cannot use it is not right — this is discussed openly before surgery.
THE MOST IMPORTANT SAFETY RULE: in a patient with a sphincter, THE CUFF MUST BE DEACTIVATED BEFORE A CATHETER IS PASSED. Passing a catheter through a closed cuff can cause permanent damage to the urethra. The patient is therefore given a device card and told to show it at any emergency department. A centre that does not say this is doing an incomplete job.
THE RIGHT TIME MATTERS MORE THAN AN EARLY ONE. Usually at least 12 months are allowed after prostate surgery, because leakage may still settle on its own. If there is a narrowing at the bladder neck, that is treated first. An operation carried out too early can mean implanting a permanent device for a problem that would have resolved.
A HISTORY OF RADIOTHERAPY CHANGES THE DECISION. In men who have had radiotherapy to the pelvis, the blood supply to the tissue is impaired and device-related problems (erosion, infection) become more likely. Surgery can still be performed, but the risks are discussed differently. If you have had radiotherapy, say so from the outset.
THE DEVICE HAS A LIFESPAN. The artificial sphincter is a mechanical system; over the years a revision may be needed for mechanical failure, thinning of the tissue beneath the cuff (atrophy) or erosion. That is not a failure but the nature of implant surgery, and it must be said to the patient at the start. If you are travelling from abroad, plan where a possible revision would be done.
Who is it suitable for?
May be suitable
- Men at least 12 months after prostate surgery with persisting significant leakage
- Men obliged to use more than one pad a day whose life is restricted by it
- Men who gain insufficient benefit from pelvic floor exercises
- Patients who have had a male sling without an adequate result
- Patients with the dexterity, eyesight and cognition to operate the device
- Patients able to attend follow-up and to carry the device card
May not be suitable
- Men less than 12 months from prostate surgery — leakage may still settle by itself
- Patients whose dexterity, eyesight or cognition will not allow them to use the pump
- Patients with untreated urinary or skin infection
- Patients with an untreated narrowing of the bladder neck or urethra: that is treated first
- Patients with an overactive bladder whose main problem is urgency — the device does not help that type
- Patients with uncontrolled bladder pressure threatening the upper urinary tract
Technology used
- Three-component artificial urinary sphincter system (cuff, reservoir, scrotal pump)
- Cystoscopic assessment of the urethra and bladder neck
- Pad test for objective measurement of leakage
- Uroflowmetry and post-void residual measurement
- Urodynamics — to demonstrate bladder storage and emptying function
- A device identity card given to the patient (shown before any catheterisation in an emergency)
Surgeon's experience
Verifiable information
- Redo (repeat surgery) rate
- Men who have already had a male sling, or who need a device revision, make up a significant part of this work.
- Complex case definition
- Patients after radiotherapy, with an accompanying bladder neck stricture, or whose previous implant has been removed are regarded as complex cases.
- Advanced technique used
- Transscrotal and perineal approaches, with transcorporal cuff placement where required.
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Review of your file
The date and operation note of your prostate surgery, the pathology report, the date and dose of any radiotherapy, your daily pad count, and any urodynamics and cystoscopy reports are reviewed. Without the pad count the severity of the problem cannot be assessed.
- Day 1
Examination and tests
Examination, pad test, uroflowmetry, residual volume, urinalysis and culture. Cystoscopy assesses the urethra and bladder neck; if there is a narrowing, the device operation is deferred and the narrowing treated first.
- Day 2
Surgery
The cuff is placed around the urethra, the reservoir inside the abdomen and the pump under the skin of the scrotum. The system is filled with fluid but left DEACTIVATED, so that the tissue can heal.
- Days 3–4
Discharge
The catheter is usually removed the following day. Because the device is deactivated in this period, leakage continues — that is expected and is not a failure.
- Days 4–8
Review
The wound and the scrotum are assessed. The return flight is planned for after this review, and your device card is given to you here.
- Weeks 4–6
Activation of the device
Once the tissue has healed the device is activated and you are taught, hands on, how to use the pump. THE REAL RESULT IS ASSESSED ONLY FROM THIS POINT. For this appointment you must either return, or arrange it in advance with a urologist in your own country.
Method comparison
| Criterion | Artificial sphincter | Male sling |
|---|---|---|
| Severity of leakage | Moderate to severe | Mild to moderate |
| Patient must operate a device | Yes — the pump, every time | No |
| History of radiotherapy | Possible, with increased risk | Result less predictable |
| Waiting for activation | Works from 4–6 weeks | Effective at once |
| Chance of mechanical failure | Yes — revision may be needed | No mechanical parts |
| Emergency catheter warning | Essential — the cuff must be opened first | Not needed |
| Size of the operation | More extensive | Smaller |
| If it is not enough | Revision | Can convert to an artificial sphincter |
The right question is not "which is stronger" but "how severe is my leakage and can I operate a device". Your pad count is the single most important piece of information for that decision, so record your daily pad use for a week before you make contact.
Risks
- INFECTION: the device is an implant; if it becomes infected the whole system usually has to be removed and re-implanted months later. This is the most serious complication
- EROSION: the cuff pressing on the wall of the urethra and opening into it. The risk is higher after radiotherapy; it requires removal of the device
- MECHANICAL FAILURE: the system can leak fluid or the pump may stop working. The device has a lifespan and revision may be needed over the years
- TISSUE ATROPHY: the tissue beneath the cuff thins with time and leakage returns. Revision with a smaller cuff may be needed
- LEAKAGE NOT RESOLVING COMPLETELY: the aim is a marked reduction in the need for pads. No device can guarantee permanent, complete dryness
- Urinary infection and difficulty passing urine
- Pain or swelling in the scrotum, or the pump being uncomfortably noticeable
- EMERGENCY RISK: passing a catheter without deactivating the cuff can permanently damage the urethra. Always carry your device card
Alternatives
- Pelvic floor exercises and physiotherapy — the first step, always tried before surgery
- Waiting and observation — leakage can lessen on its own in the first 12 months after prostate surgery
- Male sling — for mild and moderate leakage; it requires no device operation but is inadequate for severe leakage
- Urethral bulking injection — the effect is usually limited and short-lived
- A penile clamp or sheath (condom) drainage — for men who do not want, or are not suitable for, surgery
- Management with absorbent products — not a treatment but a way of coping; its effect on quality of life should not be underestimated
Recovery
First 48 hours
Swelling and bruising of the scrotum are usual. Supportive underwear is advised. Fever, inability to pass urine or discharge from the wound require immediate contact.
Weeks 1–2
The device is DEACTIVATED; leakage continues and you keep using pads. That is expected. Cycling, riding and activities that press on the area are avoided.
Weeks 2–4
Return to desk work usually falls here. Lifting and straining are avoided.
Weeks 4–6
The device is activated and its use taught. Assessment of the result begins only from this point.
Month 3
The change in daily pad use is the most intelligible measure of the result. Using the pump becomes habitual in this period.
Long term
Annual review is advised. If leakage returns, tissue atrophy or mechanical failure is looked for; both can be addressed by revision. Always carry your device card.
Frequently asked questions
Will my leaking stop completely?
The aim is a marked reduction in the need for pads. No device can guarantee permanent and complete dryness. The clearest measure of the result is the change in your daily pad count.
Do I operate the device myself?
Yes. You must squeeze the pump in the scrotum a few times every time you pass urine. That is why dexterity, eyesight and cognition are assessed before surgery. Implanting the device in someone who cannot use it is not right.
Will I be dry straight after the operation?
No. The device is left DEACTIVATED for 4–6 weeks so the tissue can heal. You will continue to leak and to use pads in that period. That is expected, not a failure.
It is six months since my prostate surgery — can I have it now?
Usually at least 12 months are allowed, because leakage may lessen on its own within that time. An operation done too early can mean a permanent implant for a problem that would have resolved.
I have had radiotherapy — can I still have surgery?
You can, but because radiotherapy impairs the blood supply to the tissue, erosion and infection become more likely. That does not mean surgery is impossible; it means the risks are discussed differently. Always tell us the date and dose.
Will the device last for life?
No. The artificial sphincter is a mechanical system; over the years revision may be needed for mechanical failure, tissue thinning or erosion. That is the nature of implant surgery and should be known from the start.
What should I do if I go to an emergency department?
Show your device card and say that THE CUFF MUST BE DEACTIVATED BEFORE A CATHETER IS PASSED. Passing a catheter through a closed cuff can permanently damage the urethra. Always carry the card.
Can I have an MRI, and will I set off airport detectors?
The device does not usually prevent imaging or security screening, but tell staff you have it and show your device card. Before a planned scan, give your device model to the radiology team.
Will it affect my sex life?
The device does not directly affect erectile function. Erectile difficulty after prostate surgery is a separate matter and can be planned alongside; in some patients a penile prosthesis is assessed at the same sitting.
How long should I stay in Türkiye?
Usually 10–14 days for the surgery and first review. But ACTIVATION of the device is 4–6 weeks later: for that appointment you must either return or arrange it in advance with a urologist at home. Plan for this from the start.
What documents should I send?
The operation note and date of your prostate surgery, the pathology report, the date and dose of any radiotherapy, YOUR DAILY PAD COUNT OVER ONE WEEK, any urodynamics and cystoscopy reports, a urinalysis and your medication list.
Scientific sources
This page is for general information only and is not a substitute for medical advice.
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