Two ways to treat stress leakage

Both treat stress leakage: urine that escapes when you cough, lift, stand up, or exercise. It is most common after prostate surgery or radiation. Both devices sit entirely inside the body, so nothing shows on the outside.

The male sling

A soft strip of mesh is placed under the urethra to support it, so it closes better when pressure rises. There is nothing to operate: you urinate normally. More about the male sling.

Usually a good fit for:

• Mild to moderate leakage

• Leakage mostly with activity rather than all the time

• In most cases, no prior pelvic radiation

• A bladder that empties well

The artificial urinary sphincter (AUS)

A soft cuff around the urethra stays closed to hold urine in. To urinate, you squeeze a small pump placed in the scrotum. The cuff opens for a few minutes, then closes again on its own. More about the AUS.

Usually a good fit for:

• Moderate to severe leakage

• Leakage after radiation

• Leakage that continued after a sling

• Men who can feel and press the pump with their fingers

The device is left off while you heal and is turned on in the office at about 6 weeks.

How the choice is made

The decision is made together at your visit, based on how much you leak, your history, and what matters most to you. Common steps:

• A pad count or a 24-hour pad weight test to measure how much you leak

• A look inside with a small camera (cystoscopy) to check the urethra and bladder neck for scar tissue

• Sometimes bladder pressure testing (urodynamics), especially if you also have urgency or trouble emptying

• A urine culture about 3 weeks before surgery, so any infection can be treated and rechecked in time

Other options

Pelvic floor therapy is often tried first in the months after prostatectomy. Adjustable balloons (ProACT) are another choice for some men with mild to moderate leakage.

After surgery

Recovery differs between the two. See Male Sling: Recovery and Artificial Urinary Sphincter: Recovery.

Your own instructions come first

Every patient is different. If the instructions you got at your visit differ from this page, follow those, and call the office at (516) 535-1900 with any question.