There are several distinct types of urinary leakage, each caused by a different mechanism — and each treated differently. Getting the right diagnosis before choosing a treatment is essential.
Most common in men after prostate surgery
Leakage that happens when pressure is put on the bladder — coughing, sneezing, laughing, lifting, or exercise. The sphincter (the valve controlling urine release) isn’t strong enough to hold against the increased pressure.
In men, this is most commonly caused by damage to the sphincter during radical prostatectomy or other prostate procedures. This page focuses primarily on post-prostatectomy stress incontinence.
Overactive bladder
A sudden, powerful urge to urinate that can’t be deferred — often resulting in leaking before reaching the toilet. The bladder muscle contracts involuntarily. Also called “overactive bladder” (OAB). q
Caused by bladder irritation, neurological conditions, prior radiation, or simply an overactive bladder muscle. Treated with bladder retraining, medications, or nerve stimulation — not surgery.
Both stress and urgency components
A combination of both types — leaking with activity AND with urgency. Common after prostate surgery, where the bladder may simultaneously have an overactive component alongside sphincter weakness.
Treatment addresses both components — urgency first (medications, behavioral therapy), then stress incontinence (sling or artificial sphincter) if the urgency component alone is insufficient.
The amount of leakage guides which treatment is most appropriate. A simple way to assess this is pad use — how many pads per day are needed to stay dry:
| Severity | Pad use | Description | Usual treatment path |
|---|---|---|---|
| Mild | 0–1 pad/day (drip or security pad) | Occasional small leaks; manageable with a pad for security | Pelvic floor therapy first; sling if persistent |
| Moderate | 1–3 pads/day | Regular leakage that restricts activity | Sling or AUS depending on sphincter function |
| Severe | 3+ pads/day; total incontinence | Continuous leakage; no control at all | Artificial urinary sphincter (AUS) is the standard |
During radical prostatectomy (surgical removal of the prostate for cancer), the external urethral sphincter — the main valve controlling urine flow — must be carefully preserved and reattached. Even in the most experienced hands, the sphincter is temporarily or permanently weakened, because it was immediately below the prostate that was just removed.
Most men experience some incontinence immediately after catheter removal post-prostatectomy. The vast majority improve significantly over the first 6–12 months as the sphincter recovers. However, about 10–15% of men will have persistent significant incontinence at 12 months that requires treatment.
It's generally recommended to wait at least 12 months after prostatectomy before surgically treating incontinence — to give the sphincter the maximum chance of natural recovery. If incontinence is still significant at 12 months, it's unlikely to improve further on its own, and a procedure is appropriate.
Other causes of male stress incontinence include: prior radiation therapy to the prostate (brachytherapy, EBRT), TURP or other prostate procedures, and trauma or injury to the sphincter mechanism from pelvic fractures.
Pelvic floor exercises — often called Kegel exercises — strengthen the external urethral sphincter and the muscles surrounding the urethra. They are the most important first step after prostatectomy and should ideally be started before surgery and continued consistently afterward.
The key is isolating the right muscles. Contract the muscles you would use to stop the flow of urine or prevent passing gas — not the abdominal, buttock, or thigh muscles. Hold for 5–10 seconds, then relax for an equal time. Aim for 10–15 repetitions, three times a day. It takes consistency — significant improvement typically takes 3–6 months.
Many men do pelvic floor exercises incorrectly — bearing down instead of lifting, or substituting other muscles. A pelvic floor physiotherapist (a specialist who works with men post-prostatectomy) can use biofeedback to ensure you're contracting the right muscles with the right technique. This significantly improves outcomes compared to doing exercises independently. Dr. Bansal can refer you to a specialist pelvic physiotherapist as part of your care plan.
A male urethral sling is a small mesh support placed under the urethra through a perineal incision (between the scrotum and rectum). It repositions and supports the urethra, improving sphincter coaptation — the ability of the urethral walls to press together and hold urine. There is no pump, no device to operate, and nothing in the scrotum — the sling works passively.
The most widely used male slings are the AdVance and AdVance XP (Boston Scientific). These mesh slings are secured to tissue on either side of the perineum and work by "relocating" the urethral sphincter to its optimal functional position. They are most effective for mild to moderate incontinence (1–3 pads/day) in men with some residual sphincter function.
Same-day or overnight procedure under general or spinal anesthesia. A catheter is removed the next day or same day. Most men are home within 24 hours and back to light activity within 2 weeks. The perineal incision is small and heals quickly. Results become apparent over the first 6 weeks as swelling resolves.
The artificial urinary sphincter (AUS) — most commonly the AMS 800™ — is the gold-standard treatment for moderate to severe post-prostatectomy incontinence. It’s an implanted hydraulic device that replaces the function of the damaged sphincter, giving you active control over when you urinate. Satisfaction rates exceed 90% in published series.
A fluid-filled cuff wraps around the urethra and gently keeps it closed — holding urine in. You are continent as long as the cuff is inflated.
Placed inside the pelvis, this balloon maintains the correct pressure in the cuff. It acts as a fluid reservoir.
A small pump is placed inside the scrotum. When you're ready to urinate, you squeeze it — fluid moves out of the cuff into the balloon, opening the urethra. After 60–90 seconds, the cuff refills automatically.
About 60–90 minutes under general or spinal anesthesia. Two small incisions are made — one in the perineum (for the cuff) and one in the lower abdomen or scrotum (for the balloon and pump). A catheter is in place during the procedure and removed the next morning. Most patients go home the next day.
The device is left switched off for 4–6 weeks after implantation — allowing the tissue around the cuff to heal without pressure. During this time, you will still be incontinent and wearing pads. Do not attempt to operate the pump during this period.
At a brief office visit, Dr. Bansal activates the device — a simple external maneuver. You're then taught how to use the pump to open the cuff before urinating. Most men achieve excellent or complete continence immediately after activation.
Using the pump becomes second nature within days — most men barely think about it. The device functions 24 hours a day. At night, you simply allow it to cycle normally. There is no pain, no visible bulge, and the pump in the scrotum is discreet under clothing.
Dr. Bansal provides every AUS patient with a medical alert card stating that you have an artificial urinary sphincter. Before any future urological procedure (cystoscopy, catheterization, prostate biopsy), the cuff must be deactivated first to prevent urethral damage. Show this card to any healthcare provider who needs to place a catheter or pass an instrument through your urethra
At least 12 months from catheter removal — and many surgeons prefer 18 months if there's still gradual improvement. The urethral sphincter can continue recovering for up to a year. Operating too early risks treating incontinence that would have resolved on its own, and also means the target tissue may not be fully stable. If you're still improving at 12 months, it's worth waiting a bit longer.
Yes — but with some caveats. Radiation affects tissue healing and vascularity, which slightly increases the risk of cuff erosion and infection compared to non-irradiated patients. Careful surgical technique, antibiotic coverage, and sometimes a perineal approach (rather than transcorporal for high-risk cases) reduce these risks. Many men with prior radiation have excellent AUS outcomes. Dr. Bansal will discuss your specific situation in detail.
AMS 800 devices are built to last, and many function for 10–15 years or more. If a component fails — typically the pump or a tube connection — it can usually be replaced without removing the entire device. If the cuff develops erosion (wearing through the urethral wall — the most serious complication), the device must be temporarily removed, the urethra allowed to heal, and then a new device placed after 3–6 months. This is manageable, though it requires patience.
Neither the AdVance sling nor the AUS directly affects erectile function — which is controlled by nerve fibers that run alongside the prostate and are not involved in either procedure. Any erectile dysfunction present before these procedures is unrelated to the incontinence surgery itself. The AUS cuff is placed around the urethra below the sphincter — away from the erectile structures.
The AdVance sling works less reliably after radiation therapy. Radiation affects the tissue mechanics that the sling relies on, and success rates are significantly lower (around 20–40%) compared to non-irradiated men (60–80%). For men who have had radiation, the artificial urinary sphincter is generally the preferred treatment.
