Male sling
A male sling is a strip of soft mesh placed under the urethra through a small incision between the legs. It lifts and supports the urethra so the remaining sphincter muscle can hold urine better, and it helps many men with mild to moderate leakage after prostate surgery.
Also called male urethral sling, transobturator male sling, AdVance sling, retrourethral sling, bulbourethral sling, sling for men, mesh sling for leaking, leaking after prostate surgery
- Where
- Hospital or outpatient surgery center operating room
- Anesthesia
- General or spinal anesthesia
- Time in the room
- About 1 hour
- Hospital stay
- Usually same day, sometimes one night
- Going home with
- A catheter, usually removed the same day or the next morning
- Back to normal
- About 2 weeks for daily activities; about 6 weeks before strenuous activity
- Back to work
- About 1 to 2 weeks for desk work; about 6 weeks for heavy work
Overview
Leakage is common after prostate cancer surgery and usually improves over the first year. When some leakage remains, and it is mild to moderate (for example, a few light pads a day), a male sling is one of the main surgical options.
The sling is a small strip of soft, woven surgical mesh. It is placed under the urethra (the tube that carries urine out) through an incision between the scrotum and anus. Its arms pass through natural openings in the pelvic bone and come out through tiny cuts in the inner groin. The most common type in the United States lifts the urethra back up into a better position, which helps the weakened sphincter muscle close.
There is nothing to squeeze or switch on. You urinate normally, and the sling works from the day of surgery. It is less effective than an artificial urinary sphincter for heavy leakage or after radiation, so matching the operation to the amount of leakage matters most.
The parts of your body involved
In men, urine is held in by the bladder neck and prostate at the top, and by the external sphincter, a ring of muscle just below the prostate. After the prostate is removed, the external sphincter does most of the work. If it is weak, or if the urethra has dropped lower after surgery, urine leaks with effort. The sling sits under the bulbar urethra, the thick part of the urethra behind the scrotum.
- Bladder
The stretchy bag that stores urine.
- External sphincter
The ring of muscle you squeeze to stop your stream. A sling works only if this muscle still has some strength.
- Bulbar urethra
The section of urethra behind the scrotum. The sling cradles it from below and lifts it.
- Perineum
The skin between the scrotum and the anus. The main incision is made here.
- Openings in the pelvic bone
Two natural openings at the front of the pelvis, one on each side, called the obturator openings. The sling arms pass through them, which anchors the sling.
Why it’s done
A sling may be recommended when leakage has stopped improving, usually 6 to 12 months or more after prostate surgery, and it is mild to moderate.
- Mild to moderate leakage
Men who use a few light pads a day tend to do best. Heavy leakage is usually better treated with an artificial urinary sphincter.
- Some sphincter strength left
The sling helps the muscle close more firmly. During a cystoscopy your surgeon can see whether the sphincter still closes when you squeeze.
- No device to operate
Some men prefer not to use a pump, or have arthritis or memory problems that would make a pump hard to use.
- No pelvic radiation
Men who have not had radiation do best. After radiation, an artificial sphincter is usually the better choice.
- Leakage that limits your life
Exercise, golf, lifting at work and intimacy are common reasons men decide to go ahead.
Other options
- Pelvic floor muscle training
Exercises to strengthen the sphincter, ideally with a pelvic floor physical therapist. Safe and worth trying first, especially in the first year after surgery.
- Artificial urinary sphincter
The most effective surgery for moderate to severe leakage and after radiation. You squeeze a pump in the scrotum each time you urinate.
- Urethral bulking injections
A gel injected into the urethra lining through a scope. Quick, but in men the benefit is usually small and short-lived.
- 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 they need ongoing care.
- Watching and waiting
If you are within the first year after surgery and still improving, waiting is often the best choice.
Getting ready
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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
You get antibiotics through an IV. Most men have general anesthesia; a spinal anesthetic, which numbs you from the waist down, is another option.
After the operation
Right afterward
- Waking up
You wake up with a catheter and some soreness between the legs and in the groin. An ice pack helps.
- Catheter out
Many surgeons remove the catheter a few hours after surgery or the next morning, then check that you can empty your bladder.
- If you cannot empty well
Swelling can make it hard to pee at first. Some men go home with a catheter for a few days. This usually settles as the swelling goes down.
- Pain medicine
Acetaminophen and an anti-inflammatory such as ibuprofen, if safe for you, handle most of the pain, with a few stronger tablets for the first days.
- Going home
Most men go home the same day or the next morning.
At home
- Groin and thigh ache
Aching in the groin or inner thighs is common, especially when you spread your legs or get out of a car. It usually fades over a few weeks.
- Swelling and wound care
Ice for 20 minutes at a time in the first 2 days and snug briefs help swelling. Shower after 24 to 48 hours; avoid baths and swimming for about 2 weeks.
- Movements to avoid
For about 6 weeks, avoid squatting, deep knee bends, spreading your legs wide, and climbing high steps. These can pull on the sling before scar tissue anchors it.
- Lifting and exercise
Walk every day. Avoid lifting more than about 10 to 15 pounds, cycling, and hard exercise for about 6 weeks.
- Peeing
Your stream may be slower at first. Take your time and empty fully. Call if you feel you cannot empty or are only dribbling.
- Bowels
Avoid constipation and straining. Drink plenty of fluids and use a stool softener while taking pain medicine.
- Driving
Do not drive while taking opioid pain medicine. Most men drive again within 1 to 2 weeks.
- Sex
Wait about 6 weeks, or until your surgeon clears you. The sling does not affect erections.
- Work
Most men return to desk work in 1 to 2 weeks. Jobs with lifting or squatting need about 6 weeks.
Recovery timeline
- Day 0Surgery
The sling is placed. Many men notice less leakage as soon as the catheter is out.
- Days 1 to 3Soreness
Groin and perineal soreness is at its worst. The stream may be slow.
- Weeks 1 to 2Back to light routine
Desk work and short drives are usually possible.
- Weeks 2 to 6Protecting the sling
Continue to avoid squatting, wide leg movements and heavy lifting while scar tissue anchors the mesh.
- About 6 weeksCheck-up
Your surgeon checks your healing and usually clears you for full activity.
- About 3 monthsSettled result
Swelling has gone down and leakage has usually reached its new baseline. Pad use and emptying are reviewed.
- 1 year and beyondLong term
For most men who do well early, the benefit lasts for years. If leakage slowly returns, other treatments, including an artificial sphincter, are still possible.
What it feels like
Most men find the recovery easier than they expected, with groin aches and a few weeks of careful movement. The emotional side is often bigger: hope that it works, and then adjusting to less leakage after a long time of managing pads.
Before surgery
Many men feel tired of pads and embarrassed to talk about leaking, and some feel uneasy about mesh after seeing news stories.
What helpsAsk your surgeon how many slings they place, what results they see in men like you, and how they handle problems.
Waking up
Soreness between the legs and in both groins, and the strange feeling of a catheter.
What helpsIce, snug briefs and regular acetaminophen. Getting up to walk early helps.
The first pee
Many men are surprised to be dry or much drier right away. The stream can feel slower, and some men need to wait a moment for it to start.
What helpsSit to pee if it helps you relax, and give it time. Call if you cannot empty.
The first week
A deep ache in the inner thighs when getting out of bed or a car, or crossing your legs.
What helpsMove slowly, keep your knees together when you get in and out of a car, and take pain medicine on a schedule for the first few days.
Weeks 2 to 6
Feeling better but having to avoid squatting, lifting and the gym can be frustrating.
What helpsWalking is encouraged. The restrictions protect the sling while your body anchors it.
Getting back to activity
Playing golf, lifting or exercising with less worry about leaking is often the moment men feel the surgery was worth it.
What helpsReturn gradually. A light pad as a safety net is fine while you build confidence.
How well it works
Success means fewer pads and less bother. Results are best in men with mild to moderate leakage who have not had radiation.
- Less leakage
In studies of well-chosen men, most use fewer pads afterward, and many become dry or use one light safety pad a day. Results are less good with heavier leakage or after radiation.
- Results usually last
For most men who do well in the first year, the benefit holds over several years, though some leakage can slowly return.
- How it is checked
Your urologist asks about pad use and how much leakage bothers you, and may check with an ultrasound that your bladder empties well.
- If it is not enough
An artificial urinary sphincter can still be placed later if needed. Having a sling does not rule it out.
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
Aching is common for several weeks, especially when you move your legs apart. It usually fades within 1 to 3 months.
In the perineum and scrotum for 1 to 2 weeks.
Many men still leak a little, especially with heavy effort.
A slower stream is common at first and usually improves as swelling settles.
Less common
Some men cannot empty well at first and need a catheter for a few days. Very few need the sling loosened.
Treated with antibiotics.
More likely with heavier leakage or after radiation. An artificial sphincter can then be placed.
Redness or drainage at an incision, usually treated with antibiotics.
Rare
Rare with male slings. The mesh may need to be removed.
Rarely, groin or perineal pain lasts beyond 3 months and needs further treatment.
Rare. It is usually recognized and repaired at the time of surgery.
Rare. 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
- You cannot pass urine, or only dribble, and your bladder feels full and painful
- Redness, warmth or pus at an incision, or swelling that keeps getting worse after the first few days
- Pain that keeps increasing instead of slowly improving
- Burning with urination along with fever or back pain
- Pain or swelling in one leg, chest pain, or sudden shortness of breath (call 911)
Questions to ask your surgeon
- Is my leakage in the range where a sling usually works well?
- Does my sphincter still close well enough for a sling?
- Which type of sling do you use, and how many do you place each year?
- Would an artificial sphincter be a better choice for me?
- Could I need radiation later, and how would that affect the sling?
- Will I go home with a catheter?
- Which movements should I avoid, and for how long?
- What happens if I cannot empty my bladder afterward?
- If the sling does not work well enough, what are the next steps?
- When can I return to golf, cycling or the gym?
Words you may hear
- Male sling
- A strip of mesh placed under the urethra to support it and reduce leakage.
- Mesh
- A soft, woven medical material that your body grows into and holds in place.
- Stress urinary incontinence
- Urine leaking with effort, such as coughing, sneezing, lifting or standing up.
- External sphincter
- The ring of muscle below the prostate area that holds urine in.
- Bulbar urethra
- The section of urethra behind the scrotum, where the sling sits.
- Obturator openings
- Two natural openings in the front of the pelvic bone that the sling arms pass through.
- Perineum
- The area of skin between the scrotum and the anus.
- Pad test
- Counting or weighing pads over a set time to measure leakage.
- Urinary retention
- Being unable to empty the bladder fully.
- Artificial urinary sphincter
- An implant with a cuff and a pump that treats heavier leakage.
- Cystoscopy
- A look inside the urethra and bladder with a thin camera.
Common questions
Will the sling make me completely dry?
Many men become dry or nearly dry, especially with mild leakage. Others leak less but still use a light pad. Your surgeon can estimate your chances based on your pad use and cystoscopy findings.
Is this the mesh I have heard about in the news?
Most of the warnings about mesh concerned products placed through the vagina to repair prolapse in women. Male slings are different products, placed differently, and remain in use. Any mesh can rarely become infected or cause pain, and your surgeon should explain these risks.
Do I have to do anything to urinate?
No. You pee normally. There is no pump or switch.
Can I still have radiation later if my PSA rises?
Yes. A sling does not prevent radiation. Radiation can make leakage worse over time in some men, and a few may later choose an artificial sphincter.
Will it affect erections or orgasm?
The sling does not affect erections. Some men find that leakage during sexual activity improves.
How soon will I know if it worked?
Many men notice a difference as soon as the catheter is out. The result settles over the first 6 to 12 weeks as swelling goes down.
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)
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.