Losing control of the bladder, even partially, affects more than physical health. It affects how people navigate daily life, including whether they accept invitations, plan outings, or sleep soundly. For many people, especially men who have had prostate surgery or radiation, this is a long - term reality that conservative treatments simply cannot resolve.
An artificial urinary sphincter is a surgically implanted device that restores the ability to hold urine. For the right candidates, it is one of the most effective and long - lasting solutions available for urinary leakage.
A small device placed inside the body to control urine flow. It supports the natural sphincter muscle using three connected parts:
This device is considered for people with significant stress urinary leakage, especially when the sphincter muscle has been damaged or weakened. It is most commonly used in:
Stress urinary incontinence occurs when pressure on the bladder, such as from laughing, lifting, or exercise, exceeds what the sphincter can hold. When the sphincter muscle is too weak to do its job, the result is leakage that is difficult to predict or prevent.
An artificial urinary sphincter directly addresses this by mechanically keeping the urethra closed until the person chooses to open it.
Pelvic floor exercises, bladder training, and medication help many people. However, for those with significant sphincter weakness, particularly following prostate surgery, these measures rarely provide sufficient control. When conservative treatments have been tried for an adequate period without meaningful improvement, surgical options are considered including an artificial sphincter are worth discussing.
Our Urology department evaluates each patient individually to determine whether surgical treatment is the right next step.
Before recommending this device, the urologist takes a thorough history, including when and how leakage occurs, what treatments have been tried, any prior surgeries, and overall health. A physical examination assesses the anatomy of the urethra and bladder.
Urodynamic tests assess how the bladder and urethra function, including how much urine the bladder can hold, the pressure at which leakage occurs, and whether the bladder contracts involuntarily. These results confirm the diagnosis and help plan treatment.
A cystoscopy, a small camera passed into the bladder, checks the health of the urethra and bladder lining. This ensures no other conditions need to be addressed before implantation.
The artificial sphincter implantation is performed under anaesthesia and takes around two hours. Through small incisions in the perineal area (the area between the scrotum and anus in men), the surgeon places the cuff around the urethra, positions the balloon in the lower abdomen, and places the pump in the scrotum. The three components are then connected by thin tubes.
The entire device sits inside the body with no external parts.
After surgery, patients usually remain in hospital for one to two days. The device is left deactivated — the cuff stays open so the urethra can heal without pressure. Mild discomfort and some swelling are expected and settle within a few weeks.
The device is typically activated four to six weeks after surgery, once the urethra has healed. This is done at an outpatient appointment by the Urology team headed by Dr Sanjay Pandey.
Operating the pump becomes straightforward with practice. Before urinating, the person squeezes the pump in the scrotum or labia. This opens the cuff, urine passes, and the cuff closes again on its own. Most people find it becomes second nature within a few weeks.
Most people return to light daily activities within two to four weeks. Physical activity, particularly anything that strains the pelvic area, should be avoided for four to six weeks. The device is typically activated at the follow up visit, around four to six weeks after surgery.
Regular follow up appointments allow the surgical team to check how the device is functioning, assess continence outcomes, and address any concerns. Annual reviews are generally recommended long-term.
By keeping the urethra mechanically closed, the device restores the ability to retain urine until it is convenient to use the toilet, reducing or eliminating unpredictable leakage that can significantly affect quality of life.
Most people who receive an artificial urinary sphincter experience a significant reduction in urine leakage. Many achieve complete or near-complete continence. Results depend on the severity of the original incontinence, the health of the urethra, and how the device is used.
The device is designed to last many years, though revision surgery may eventually be needed.
As with any implant surgery, complications are possible:
Most complications are manageable, and the long term revision rates for this device are well understood.
Contact your surgical team if you notice:
At Kokilaben Dhirubhai Ambani Hospital, our urology team provides specialist assessment and surgical treatment for urinary leakage, including artificial urinary sphincter implantation for appropriate candidates.
Who is an artificial urinary sphincter recommended for?
It is most commonly recommended for men with significant urinary leakage following prostate surgery or radiation and for selected patients with neurological causes of incontinence. Women may be considered in specific cases when other surgical options have not been effective.
What happens during artificial urinary sphincter implantation?
Under anaesthesia, a cuff is placed around the urethra, a balloon is positioned in the abdomen, and a pump is placed in the scrotum or labia. The procedure typically takes one to two hours. The device is left inactive for several weeks while the urethra heals.
When is an artificial urinary sphincter activated?
Activation is performed by the surgical team at an outpatient visit, usually four to six weeks after the initial surgery. The person is then shown how to operate the pump and can begin using the device from that point.
What other urinary incontinence surgery options are available?
Other surgical options include male sling procedures for milder leakage, bulking agent injections, and bladder neck surgery. The most appropriate option depends on the degree of leakage, the condition of the sphincter, and prior treatment history, all of which are assessed during the presurgical evaluation.
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