What Is Daily Life Like With an Artificial Urinary Sphincter?
An artificial urinary sphincter, often shortened to AUS, is a small implanted device designed to improve bladder control. It is most commonly used for men who have ongoing urinary leakage after prostate surgery, although it may also be suitable for some people with other causes of severe stress urinary incontinence.
Current guidelines recommend discussing an AUS with men who have persistent urinary leakage, particularly when pelvic floor exercises and other simpler treatments have not provided enough improvement.[1,2]
For many people, the biggest change after receiving an AUS is not simply using fewer pads. It is being able to leave the house, exercise, socialise and travel with much more confidence. However, the device does require a small action each time you urinate, and it must be protected during future medical procedures.
How does an artificial urinary sphincter work?
The device usually has three connected parts:
A soft cuff that sits around the urethra—the tube that carries urine out of the bladder
A small control pump placed beneath the skin of the scrotum
A pressure-regulating balloon placed deeper inside the body
Most of the time, the cuff gently closes the urethra and helps prevent urine from leaking. When you need to urinate, you squeeze the pump in the scrotum. This temporarily moves fluid out of the cuff, allowing the urethra to open.
After several minutes, the cuff automatically refills and closes again.[3]
There are no batteries, external controls or electronic charging systems in a traditional AUS.
What is it like to use the device?
Once the device has been activated and you have learned where the pump is located, using it usually becomes a quick and familiar routine.
When you feel the need to urinate:
Locate the pump through the skin of the scrotum.
Squeeze and release the lower part of the pump.
Wait briefly for the cuff to open.
Urinate normally.
The device closes again automatically.
You do not need to press another button after urinating. The cuff usually takes a few minutes to refill, giving you time to empty your bladder.[3]
Most people become comfortable using the pump after practising with their surgeon or continence nurse. However, an AUS may be difficult to use if you have significant arthritis, poor hand strength, reduced finger movement, memory problems or difficulty feeling the pump.
Will I be completely dry?
An AUS offers very good bladder control for many people, but complete dryness cannot be guaranteed.
In published studies, a large proportion of men achieve either:
No pad use
Only one small security pad each day
A major reduction in the number and size of pads they require
Studies have found that most appropriately selected patients experience a substantial reduction in leakage after AUS surgery. Many become completely pad-free, while others continue to use a small security pad.[4-7]
Some leakage may still occur when:
The bladder is very full
You cough, sneeze or lift something heavy
You delay going to the toilet
You have bladder urgency or an overactive bladder
The cuff or another part of the device is no longer working properly
The AUS mainly treats stress urinary leakage. This means leakage caused by physical pressure, such as coughing, standing, walking or exercise.
It does not always treat urgency—the sudden and difficult-to-delay need to urinate. Urgency and overactive bladder symptoms may need to be treated separately.
Will other people know I have one?
Usually not.
The entire device is placed inside the body. The pump can be felt through the skin of the scrotum, but it is generally not visible through clothing. The abdominal balloon and urethral cuff cannot normally be felt from outside the body.
You may notice the pump when washing or examining yourself. Over time, most people become much less aware of it.
Can I return to normal activities?
Following recovery, most people can return to everyday activities, including:
Walking and general exercise
Working
Driving
Swimming
Golf
Travel
Sexual activity
Social and family activities
During the first few weeks after surgery, your surgeon will normally ask you to avoid heavy lifting, strenuous exercise and activities that place pressure between the legs.
The device is usually left switched off while the tissues heal. It is commonly activated approximately four to six weeks after surgery, although the timing depends on your recovery and your surgeon’s advice.[3]
Cycling, horse riding and prolonged sitting on narrow or hard seats can place pressure near the cuff and pump. Some specialists recommend limiting prolonged cycling or using a wide, pressure-relieving saddle once you have recovered.
Your surgeon can provide advice based on the position of the device and the activities you intend to undertake.
Can I have sex normally, and what happens to ejaculation?
Once the surgical wounds have healed, an artificial urinary sphincter does not normally prevent sexual activity.
The AUS does not directly control:
Erections
Sexual sensation
Orgasm
Sexual desire
The pump can be felt inside the scrotum, but most people and their partners become accustomed to its position. You do not usually need to switch off or deactivate the AUS before sex.
It is important to understand that orgasm and ejaculation are not the same thing.
An orgasm is the pleasurable sensation of reaching sexual climax. Ejaculation is the release of semen from the penis.
Many men who receive an AUS have previously undergone a radical prostatectomy for prostate cancer. During a radical prostatectomy, the prostate and seminal vesicles—which produce most of the fluid in semen—are removed.
As a result, semen can no longer be released during sex. A man may still experience an orgasm, but it will usually be a dry orgasm, with little or no fluid coming from the penis.[10]
This loss of ejaculation is caused by the earlier prostate cancer operation, not by the artificial urinary sphincter. Implanting an AUS does not restore ejaculation.
Men who receive an AUS for another reason and still have their prostate may retain some ability to ejaculate. However, ejaculation may already have been affected by:
Previous prostate or bladder surgery
Radiotherapy
Nerve damage
Spinal cord or neurological conditions
The underlying urinary condition
Because the AUS cuff sits around the urethra, it may also reduce the ease with which semen passes through the urethra in men who still produce semen. The effect varies between individuals and should be discussed with the surgeon before treatment.
Some men leak urine during sexual arousal or at the moment of orgasm. This is known as climacturia, or orgasm-associated urinary leakage.
Improving overall bladder control with an AUS may reduce this leakage and improve sexual confidence, but it may not stop climacturia completely.[11,12]
Practical steps that may help include:
Emptying your bladder shortly before sex
Using a towel or absorbent pad until you know how much leakage remains
Discussing persistent leakage during orgasm with your urologist
Waiting until your surgeon confirms that the wounds have healed before resuming sexual activity
Will I still need to plan toilet visits?
Most people no longer need to plan their day around pads and leakage to the same extent. However, it remains sensible to:
Avoid allowing the bladder to become painfully overfull
Go to the toilet when you have a reasonable urge
Allow enough time to locate and operate the pump
Carry a spare pad when travelling, particularly soon after activation
Know where toilets are during long journeys
People with urinary urgency or an overactive bladder may still need to visit the bathroom frequently. These symptoms can often be investigated and treated separately.
What happens when I travel?
You can generally travel normally with an AUS.
You should carry the implant identification card supplied with the device. Airport security scanners may detect the implant, although this does not usually cause a significant problem. Showing the card can help explain that you have an implanted medical device.[3]
When travelling, it is sensible to keep:
Your implant card in your wallet
A photograph or electronic copy of the implant details on your phone
Your surgeon’s contact details
A medical alert card or bracelet
A small supply of pads in case your leakage changes
The AUS does not normally prevent travel by plane, including long-distance travel.
The most important safety rule
This is the most important practical issue for anyone living with an artificial urinary sphincter.
A urinary catheter must not be passed through the urethra while the AUS cuff is closed.
Passing a catheter through a closed cuff can injure the urethra, damage the device and increase the risk of erosion or infection. The AUS must first be properly deactivated by someone who understands how the device works.[3]
Tell every doctor, nurse, emergency department and hospital that you have an artificial urinary sphincter before:
A urinary catheter is inserted
A camera examination of the bladder is performed
Any procedure is performed through the urethra
You undergo surgery during which catheterisation may be required
Keep your implant identification card in your wallet or saved on your phone.
If you are unable to urinate, tell emergency staff immediately that you have an AUS. Do not allow repeated attempts at catheter insertion without the device first being assessed and deactivated.
Can I have an MRI scan?
MRI safety depends on the exact device model and the settings of the MRI scanner.
The commonly used AMS 800 is classified as MR Conditional. This means that an MRI may be performed under certain specified conditions.[3]
You must tell the radiology staff that you have an artificial urinary sphincter and provide your implant details. They can then check the correct safety information for your particular device before the scan.
Do not assume that every implanted urinary device has the same MRI conditions.
How long does an artificial urinary sphincter last?
An AUS should not be considered a lifetime device. It contains moving mechanical components and may eventually require adjustment, replacement or removal.
Large long-term studies suggest that approximately:
70–75% of devices remain free from further surgery at five years
Just over half remain free from further surgery at ten years
The likelihood of requiring revision increases with longer follow-up
The lifespan varies considerably between individuals. Some devices continue to work well for much longer, while others require earlier revision because of:
Mechanical wear or failure
Infection
Urethral erosion
Movement or poor positioning of the pump
Changes in the urethra
A gradual return of urinary leakage
Needing revision surgery does not necessarily mean that choosing an AUS was unsuccessful. The device is a mechanical implant that may be operated several times every day for many years.[7,8]
What changes should I report to my surgeon?
Contact your urologist if you notice:
A sudden or gradual increase in leakage
Increasing difficulty operating the pump
A pump that feels unusually hard, flat or different
Difficulty or inability to urinate
Blood in the urine
New pain in the scrotum, perineum or urethra
Redness, swelling or discharge from the surgical area
Fever or feeling generally unwell
Part of the device becoming visible through the skin
Recurrent urinary infections
A gradual return of leakage may be caused by changes in the urethra or normal wear of the device. A sudden inability to urinate requires urgent medical assessment.
Infection and erosion are uncommon but important complications because they may require removal of the device.[9]
Is there any regular maintenance?
There is no charging, refilling or routine home maintenance.
You should:
Use the pump whenever you urinate
Attend your recommended follow-up appointments
Keep your implant information available
Tell healthcare professionals about the device
Avoid unnecessary pressure or trauma to the area
Contact your surgeon if the device feels or behaves differently
Your specialist may check your urine flow, bladder emptying, pad use and the position or function of the pump, particularly if your symptoms change.
Is an artificial urinary sphincter worth it?
For appropriately selected patients, an AUS can make a major difference to independence and quality of life.
Studies consistently report high patient satisfaction and sustained improvement in the social and emotional effects of urinary leakage.[5-7]
The main trade-offs are that you must:
Operate the pump each time you urinate
Protect the device during catheterisation and other urethral procedures
Accept that further surgery may eventually be required
For many people, these responsibilities are outweighed by the ability to exercise, work, travel and socialise with far less fear of leakage.
Take home message
An artificial urinary sphincter:
Is completely contained inside the body
Requires a brief pump squeeze each time you urinate
Usually produces a major reduction in urinary leakage
Does not guarantee complete dryness
Usually allows normal work, travel, exercise and sexual activity after recovery
Does not normally prevent erections or orgasm
Does not restore ejaculation lost after radical prostatectomy
May reduce, but does not always eliminate, urinary leakage during orgasm
Must be deactivated before urethral catheterisation
May eventually require revision or replacement
Your individual result will depend on your bladder function, previous surgery or radiotherapy, hand function, urethral health and the severity of your leakage.
A reconstructive or continence urologist can explain how these factors apply to you.
References
American Urological Association. Incontinence after prostate treatment: AUA/GURS/SUFU guideline. Linthicum (MD): American Urological Association; 2024.
European Association of Urology. EAU guidelines on the management of non-neurogenic male lower urinary tract symptoms, including male urinary incontinence. Arnhem: European Association of Urology; 2025.
Boston Scientific Corporation. AMS 800 artificial urinary sphincter: patient guide for male patients. Marlborough (MA): Boston Scientific; 2025.
Artificial Urinary Sphincter Clinical Outcomes Trial Investigators. Artificial urinary sphincter clinical outcomes: prospective continence and safety outcomes at 12 months. J Urol. 2026.
Kahlon B, Baverstock RJ, Carlson KV. Quality of life and patient satisfaction after artificial urinary sphincter. Can Urol Assoc J. 2011;5(4):268-72.
Montague DK. Artificial urinary sphincter: long-term results and patient satisfaction. Adv Urol. 2012;2012:835290.
Boswell TC, Elliott DS, McGuire EJ, et al. Long-term device survival and quality of life outcomes following artificial urinary sphincter placement. Transl Androl Urol. 2020;9(1):56-61.
Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic. Urology. 2015;86(3):602-7.
Frazier RL, Drobish JN, Brant WO. Artificial urinary sphincter complications: a narrative review. J Clin Med. 2024;13(7):1913.
Green TP, Saavedra-Belaunde JA, Wang R. Ejaculatory and orgasmic dysfunction following prostate cancer therapy: clinical management. Med Sci (Basel). 2019;7(10):100.
Urkmez A, Topaktas R, Ozsoy E, Topaktas M, Sahin A, Kocaaslan R, et al. Effect of artificial urinary sphincter implantation on erectile function and sexual satisfaction. Andrologia. 2019;51(7):e13295.
Kannady C, Clavell-Hernández J. Orgasm-associated urinary incontinence following radical prostatectomy: a review of pathophysiology and current treatment options. Asian J Androl. 2020;22(5):481-5.
This article provides general information and should not replace individual medical advice from your surgeon.
