Artificial urinary sphincter
An artificial urinary sphincter is a small fluid-filled implant that keeps the urethra squeezed closed to stop leakage, and opens when you press a pump hidden in the scrotum. It is the most studied surgery for men who leak a lot after prostate cancer treatment.
Also called AUS, AMS 800, artificial sphincter, urinary sphincter implant, sphincter implant for leakage, incontinence after prostate surgery, leaking after prostatectomy, pump in the scrotum for leaking
- Where
- Hospital or outpatient surgery center operating room
- Anesthesia
- General anesthesia, or a spinal anesthetic
- Time in the room
- About 1 to 2 hours
- Hospital stay
- Same day or one night
- Going home with
- A thin catheter, usually removed the next morning or before you go home
- Back to normal
- About 2 to 4 weeks for daily activities; the device is turned on at about 6 weeks
- Back to work
- 1 to 2 weeks for desk work; about 6 weeks for heavy physical work
Overview
Many men leak urine after prostate cancer surgery. For most, it gets better over the first year as the muscle that holds urine in (the sphincter) recovers. For some it does not, and they keep leaking when they cough, stand up, lift or walk. An artificial urinary sphincter, often called an AUS, is a small implant that takes over the job of that muscle.
The device has three parts, all filled with sterile salt water and joined by thin tubes. A soft cuff wraps around the urethra (the tube that carries urine out). A small balloon sits low in the belly and keeps the cuff gently squeezed. A small pump sits in the scrotum (the skin sac that holds the testicles). When you want to urinate, you squeeze the pump a few times. The cuff opens, you empty your bladder, and the cuff closes again by itself a few minutes later.
Everything is inside your body, and nobody can see it. The device is placed in one operation, then left switched off for about 6 weeks while you heal. Your urologist then turns it on in the clinic and teaches you how to use it.
Versions of this device have been used since the 1970s, and the AUA/SUFU guideline lists it as a standard option for men with bothersome leakage after prostate treatment. Most men leak much less afterward and are glad they had it. Few become perfectly dry, and because it is a mechanical device, some men need a repair or replacement in later years.
The parts of your body involved
Urine is stored in the bladder and leaves through the urethra. In men, two things normally keep urine in: the bladder neck and prostate at the top, and a ring of muscle just below the prostate called the external sphincter. Removing the prostate takes away the first barrier and can weaken the second. The AUS cuff goes around the urethra a little lower down, in a section called the bulbar urethra, which lies behind the scrotum between the legs.
- Bladder
The stretchy bag that stores urine until you are ready to empty it.
- External sphincter
The ring of muscle you squeeze to stop your stream. When it is weak, urine leaks with effort, such as coughing or standing up.
- Bulbar urethra
The section of the urethra behind the scrotum. It is thick and well padded, which makes it the usual spot for the cuff.
- Scrotum
The skin sac that holds the testicles. The pump sits here, next to one testicle, where your fingers can find it easily.
- Space beside the bladder
The balloon sits in a natural space behind the lower belly muscles, next to the bladder. You cannot feel it.
Why it’s done
Your urologist may suggest an AUS when leakage still bothers you after enough time to recover, usually at least 6 to 12 months after prostate surgery, and simpler steps have not been enough.
- Moderate to severe leakage
If you use several pads a day or soak through them, the AUS is the most effective surgery. A male sling works best for lighter leakage.
- Leakage that has stopped improving
Most recovery happens in the first year after prostatectomy. If your pad use has been steady for a few months, more waiting is less likely to help.
- Pelvic floor exercises were not enough
Pelvic floor muscle training (Kegel exercises), often with a physical therapist, is usually tried first.
- Leakage after radiation
Men who have had pelvic radiation tend to do poorly with a sling. An AUS still helps many of them, although the risks of infection and wear are higher.
- A sling or earlier device that did not work
An AUS can be placed after a male sling that did not control leakage, or to replace an older sphincter.
- Getting back to your life
Leakage keeps many men from exercise, work, travel and intimacy. The goal is to let you return to the things you have stopped doing.
Other options
- Pelvic floor muscle training
Exercises to strengthen the sphincter, ideally taught by a pelvic floor physical therapist. Most helpful in the first year after surgery. Safe, and worth trying first.
- Male sling
A strip of soft mesh placed under the urethra through one small incision between the legs. Nothing to squeeze or switch on. Works best for mild to moderate leakage in men who have not had radiation.
- Urethral bulking injections
A gel injected into the lining of the urethra through a scope. Quick, but in men the benefit is usually small and short-lived, and guidelines say a cure is unlikely.
- Adjustable balloons
Two small balloons placed beside the urethra that can be topped up in the clinic. Offered at some centers for mild leakage.
- Pads, a penile clamp, or a condom catheter
Products that absorb or collect urine, or gently squeeze the penis closed. No surgery, but a clamp must be released every couple of hours and can be uncomfortable.
- Watching and waiting
If leakage is mild or still improving, waiting is reasonable. Surgery can be done later if you change your mind.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The night before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
In the operating room you get antibiotics through an IV. Most men have general anesthesia and are fully asleep. A spinal anesthetic, which numbs you from the waist down, is another option.
After the operation
Right afterward
- Waking up
You wake up in the recovery room with a catheter in place and an ice pack on the scrotum. Most men describe soreness between the legs rather than sharp pain.
- The catheter
Many surgeons take the catheter out a few hours after surgery or the next morning, before you go home.
- Peeing before you leave
After the catheter comes out, the team checks that you can pass urine. Because the device is switched off, you will leak much as you did before surgery.
- Medicines
You get IV antibiotics around the time of surgery, and some surgeons send you home with a few days of antibiotic pills. Pain is usually controlled with acetaminophen, an anti-inflammatory such as ibuprofen if it is safe for you, and a small supply of stronger medicine.
- Going home
Most men go home the same day or the next morning.
- Your device card
You will receive a card that says you have an artificial urinary sphincter. Keep it in your wallet. Some men also wear a medical alert bracelet.
At home
- Swelling and bruising
The scrotum often swells and bruises, sometimes turning purple, for 1 to 2 weeks. Ice wrapped in a cloth for 20 minutes at a time during the first 2 days, and snug briefs for several weeks, both help.
- Wound care
Most surgeons allow a shower after 24 to 48 hours; pat the incisions dry. Avoid baths, hot tubs and swimming for at least 2 weeks, or until your surgeon says the incisions have healed.
- Still leaking for now
The device is off for about 6 weeks, so keep using pads. Do not squeeze the pump during this time unless your surgeon has asked you to.
- Positioning the pump
Some surgeons ask you to gently pull the pump down toward the bottom of the scrotum once or twice a day, so it heals in an easy-to-reach spot. Do this only if your team asks you to.
- Activity and lifting
Walk every day. Avoid lifting more than about 10 to 15 pounds, straining and hard exercise for about 6 weeks.
- No straddle seats
Avoid bicycles, motorcycles, horseback riding and other straddle seats for at least 6 weeks, because they press directly on the cuff. Many surgeons also advise limiting long rides on narrow bike seats for as long as you have the device.
- Bowels
Pain medicine can cause constipation. Drink plenty of fluids and use a stool softener so you do not strain.
- Driving
Do not drive while taking opioid pain medicine. Most men drive again within 1 to 2 weeks, once sitting is comfortable.
- Sex
Wait about 6 weeks, or until your surgeon clears you. The device does not affect erections or orgasm.
- Catheters in the future
For the rest of your life, anyone who needs to put a catheter or scope into your urethra must know about the device first, so the cuff can be opened and locked. Show your device card every time.
Recovery timeline
- Day 0Surgery
The device is placed and switched off. Most men go home the same day or the next morning.
- Days 1 to 3Catheter out, soreness peaks
The catheter is usually out by now. Swelling and soreness are at their worst. You leak as you did before.
- Weeks 1 to 2Bruising fades
Sitting becomes easier. Many men are back to desk work and short drives.
- About 6 weeksActivation visit
In the clinic, your urologist squeezes the pump firmly to unlock the cuff. You practice cycling the pump until you can do it smoothly.
- Weeks 6 to 12Learning the routine
Using the pump becomes a habit. Leakage usually drops right away, and the pump gets easier to find as the last swelling settles.
- About 3 monthsCheck-up
Your urologist reviews your pad use, checks that you empty your bladder well, and answers questions.
- Every yearYearly visit
A short check of how the device works and how much you leak.
- 5 to 10 years and beyondLong term
Many devices work for 10 years or more. Some men need a repair or replacement when a part wears out or the urethra thins under the cuff.
What it feels like
Most men describe the operation as sore but manageable. The harder parts are often emotional: waiting six more weeks to be dry after months of leaking, and learning to trust a device you cannot see.
Before surgery
Many men feel a mix of hope and embarrassment. Talking about leaking, and about a pump in the scrotum, is not easy.
What helpsYour urologist has this conversation often. Ask every question, including the awkward ones, and bring your partner if you would like.
Waking up
A dull ache between the legs and a full, heavy feeling in the scrotum. The catheter can make you feel like you need to pee.
What helpsIce, snug briefs and regular acetaminophen. Tell the nurse if the urge feels strong; it usually eases once the catheter is out.
The first week at home
Sitting is uncomfortable, and the scrotum can look alarmingly swollen and bruised. You are still leaking, which can be discouraging.
What helpsSit on a soft cushion, keep ice going for the first two days, and remember that the device is meant to be off for now. The swelling goes down over 1 to 2 weeks.
The waiting weeks
Six weeks can feel long when you have already waited months. Some men wonder whether anything was done, because nothing has changed yet.
What helpsKeep using pads, keep walking, and mark the activation date on the calendar. The wait protects the urethra while it heals around the cuff.
Activation day
The first squeezes of the pump can be tender, and finding it takes practice. Many men feel real relief walking out of the clinic dry, or nearly dry, for the first time in months.
What helpsPractice with the nurse until you can find and squeeze the pump smoothly. Take written instructions home.
Getting used to the pump
At first you have to think ahead: squeeze, then pee. Some men find the stream a little slower than before.
What helpsFor most men cycling becomes second nature within a few weeks. Sitting to urinate can make it easier at first.
The first dry cough or golf swing
Many men describe the day a cough, a sneeze or a full golf swing no longer meant leaking as the day they got their life back.
What helpsExpect a little leakage with heavy straining or late in a long day. Many men keep one light pad as a safety net.
How well it works
Success is measured by how many pads you use and how much leakage bothers you. The device rarely makes men perfectly dry, but it usually makes a big difference.
- Much less leakage
In large studies, most men go from several pads a day to none or one light safety pad. Men with very heavy leakage before surgery, or who had radiation, tend to leak somewhat more.
- High satisfaction
Most men say they are satisfied and would choose the surgery again.
- How it is checked
Your urologist asks about pad use, may repeat a pad test, and may check with an ultrasound that your bladder empties well after you pee.
- How long it lasts
Because the AUS is mechanical, a fair number of men need another operation within 5 to 10 years to fix or replace part of it. That surgery is usually planned and often shorter than the first.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Very common in the scrotum and perineum for 1 to 2 weeks.
Between the legs and in the scrotum, mostly in the first 1 to 2 weeks. The pump can be tender when you first start using it.
Light leakage, especially with heavy effort or late in the day, is common even when the device works well.
Parts can leak or wear out, or the urethra can thin under the cuff. Leakage returns, and the part or device is replaced.
Less common
Swelling can make it hard to pee for a short time after surgery or after activation. A catheter may be needed for a few days.
Treated with antibiotics. Call if you have burning, fever, or cloudy, foul-smelling urine.
Bacteria can settle on the implant. This usually means removing the whole device, letting things heal for a few months, and placing a new one later.
The cuff can wear through into the urethra, causing pain, swelling, blood, or new leakage. The device is removed and the urethra is allowed to heal. Radiation and catheters passed through a closed cuff raise this risk.
Over years the urethra under the cuff can thin and leakage slowly returns. A smaller cuff or a second cuff can fix this.
Some men find the pump hard to find or squeeze, especially with arthritis or reduced feeling in the fingers.
Rare
If it happens it is repaired, and placing the device may be delayed until healing is complete.
Ongoing pain in the scrotum or perineum after healing is uncommon.
Clots in the legs or lungs are rare after this surgery. Walking soon after surgery lowers the risk.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Redness, warmth or pus at an incision, or a scrotum that becomes more red, hot and swollen after the first few days instead of less
- You cannot pass urine, or only dribble, and your bladder feels full and painful
- New or worsening pain in the scrotum or between the legs, or skin over the pump that looks thin, shiny or broken
- Blood from the tip of the penis or in the urine after the first week
- Heavy leakage that suddenly returns after the device had been working
- Pain or swelling in one leg, chest pain, or sudden shortness of breath (call 911)
Questions to ask your surgeon
- How much do you expect my leakage to improve, given my pad use and history?
- Am I a better fit for a male sling or an artificial sphincter, and why?
- Does my history of radiation change the risks for me?
- How many of these devices do you place each year?
- Will you use one incision or two, and where will they be?
- Will I go home the same day, and when will the catheter come out?
- When will the device be activated, and who will teach me to use it?
- What should I do if I cannot find or squeeze the pump?
- Which activities, such as cycling, should I avoid long term?
- What happens if the device stops working or becomes infected?
- Can I have a penile implant too, and in what order?
Words you may hear
- Artificial urinary sphincter (AUS)
- An implant with a cuff, a balloon and a pump that keeps the urethra closed until you open it.
- Stress urinary incontinence
- Urine leaking with effort, such as coughing, sneezing, lifting or standing up.
- Urethra
- The tube that carries urine from the bladder out through the penis.
- Bulbar urethra
- The thick section of urethra behind the scrotum, where the cuff usually goes.
- Perineum
- The area of skin between the scrotum and the anus.
- Cuff
- The soft, fluid-filled band that wraps around the urethra and squeezes it closed.
- Pressure-regulating balloon
- The fluid reservoir in the lower belly that sets how firmly the cuff squeezes.
- Pump
- The small control in the scrotum that you squeeze to open the cuff.
- Cycling
- Squeezing the pump to open the cuff, emptying your bladder, and letting the cuff refill on its own.
- Deactivation
- Locking the cuff open with a button on the pump, used after surgery and before any catheter is passed.
- Activation
- Unlocking the device in the clinic, usually about 6 weeks after surgery.
- Erosion
- When the cuff wears through into the urethra; the device must then be removed.
- Urethral atrophy
- Thinning of the urethra under the cuff over time, which lets leakage return.
- Pad test
- Counting or weighing pads over a set time to measure how much urine leaks.
- Cystoscopy
- A look inside the urethra and bladder with a thin camera.
Common questions
Will anyone be able to see or feel the device?
No one can see it. You or a partner may feel the pump in the scrotum as a small, smooth bump next to a testicle.
Why do I have to wait about 6 weeks for it to work?
The tissues around the cuff need time to heal and the swelling needs to settle. Squeezing a swollen, healing urethra raises the risk that the cuff wears through.
What if I need a catheter in the future?
A catheter passed through a closed cuff can injure the urethra. Before any catheter, scope or surgery, tell the team you have an artificial sphincter and show your card. A urologist or a trained nurse can open and lock the cuff first. If you are taken to an emergency room, ask them to call a urologist before placing a catheter.
Will it affect erections or sex?
It does not affect erections or orgasm. Some men who leaked during sex notice that this improves. You can cycle the pump and empty your bladder before sex.
Can I go through airport security or have an MRI?
Carry your device card when you travel. Current devices are generally labeled as safe for MRI under specific conditions, so tell the MRI team about the implant ahead of time so they can confirm.
How long does it last?
Many keep working for 10 years or more, but parts can wear out. Replacing part or all of the device is usually a shorter operation than the first one.
Am I too old for this?
Age alone is not the main question. What matters more is your general health, whether you can work the pump reliably, and whether your bladder empties well. Many men in their 70s and 80s have this device.
Sources this page draws on
- American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)
- European Association of Urology (EAU), Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms
- European Urology, MASTER randomized trial: male synthetic sling versus artificial urinary sphincter for stress incontinence after prostate surgery (2021)
- Urology Care Foundation, Stress Urinary Incontinence (SUI)
- MedlinePlus, U.S. National Library of Medicine, Artificial urinary sphincter
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.