Medical Oncologist
CION Cancer Clinics
Treatment for persistent incontinence after prostatectomy | CION Cancer Clinics
If you are still leaking well after the first year following a prostatectomy, there are treatments that work. The main ones are a supervised physiotherapy programme, tablets where the bladder is overactive, a sling placed under the tube to support it, and an artificial sphincter, a small implanted cuff you open by squeezing a pump. This page explains the tests that come first, what each option involves, who it does not suit, and what to ask your centre. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What can be done if leaking has not settled after prostatectomy?
- What tests are done first?
- What treatments are there, and who is each for?
- Sling and artificial sphincter, compared
- The terms in the clinic, in plain language
- Things men tell us, and what is actually true
- What this page cannot tell you, and who these do not suit
- Common questions about treating lasting leakage
The short answer
What can be done if leaking has not settled after prostatectomy?
If you are still leaking well after the first year, there are treatments that work. The main ones are a supervised physiotherapy programme, a sling placed under the tube to support it, and an artificial sphincter, a small implanted cuff that you squeeze open to pass urine. Which one suits you depends on how much you leak and why.
Why the first year matters
Most surgeons wait until around a year after the operation before offering a procedure, because the muscle keeps recovering for that long and many men become dry without any of it. Waiting past that point, on the other hand, rarely adds anything. If you are past a year and still using several pads a day, it is time for the conversation.
What "persistent" means here
Teams usually mean leaking that has stopped improving and still needs pads daily. That covers a wide range, from a light pad on long days to soaking several pads before lunch. The treatment for each end of that range is different, which is why a proper assessment comes before any decision.
Urgency, the sudden need to rush, is handled differently from leaking on effort. Both can persist, and both have treatment.Before anything is offered
What tests are done first?
A bladder diary and pad count
You record for a few days what you drink, when you pass urine, and when you leak. Pads may be weighed after a set period to measure how much escapes. This puts a number on the problem and sorts light from heavy leakage.
Checking the bladder empties
A simple scan after you pass urine shows whether the bladder empties fully. Leaking from an overfull bladder is a different problem with a different fix, and it is important not to miss it.
A look inside the tube
A thin flexible camera is passed along the tube to check the join the surgeon made and to rule out narrowing or scar tissue. It takes a few minutes with local anaesthetic gel and most men find it uncomfortable rather than painful.
A pressure test of the bladder
Called urodynamics. Fine tubes measure pressure while the bladder fills and empties. It tells the team whether the sphincter is weak, the bladder is overactive, or both, which decides which treatment makes sense.
Not sure whether this applies to you?
Ask an oncologistThe options
What treatments are there, and who is each for?
From least to most involved. Most men are offered them roughly in this order.
Supervised pelvic floor training
A physiotherapist checks your technique, often with a small sensor that shows the squeeze on a screen, and builds a programme over several months.
Usually for
- Light to moderate leakage
- Any man before a procedure
Tablets for urgency
Where the tests show an overactive bladder, tablets that calm it can reduce the rush and the leaks that come with it. They do nothing for leaking on effort.
Your prescribing doctor sets the choice and the dose.Male sling
A strip of mesh placed under the tube through a small cut behind the scrotum, lifting and supporting it so it closes better. Nothing to operate afterwards.
Usually for
- Mild to moderate leakage
- No radiation to the area
Artificial urinary sphincter
A soft cuff around the tube, a small pump in the scrotum and a balloon in the belly, all under the skin. The cuff stays closed; you squeeze the pump to open it and pass urine. It is the standard treatment for heavy leakage.
Usually for
- Moderate to heavy leakage
- Men who can work a pump with their hand
Side by side
Sling and artificial sphincter, compared
Male sling
Artificial sphincter
Sling: suits lighter leakage, with some sphincter strength left
Sphincter: suits heavier leakage, including after radiation
Sling: nothing to operate; you pass urine as normal
Sphincter: you squeeze a pump in the scrotum each time you go
Sling: if it does not work, a sphincter can still be placed later
Sphincter: parts can wear or fail over years and may need replacing
Sling: not offered where the tube has scarred or been irradiated
Sphincter: needs good hand function and the ability to attend for checks
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Words you will hear
The terms in the clinic, in plain language
- Urodynamics
- The pressure test of the bladder. It separates a weak sphincter from an overactive bladder, which need different treatment.
- Bulking injection
- A gel injected around the tube to narrow it. Used less often, for light leakage, and its effect tends to fade with time.
- Cuff
- The part of an artificial sphincter that wraps the tube and holds it closed.
- Activation
- An artificial sphincter is left switched off for several weeks after it is placed, to let things heal, then turned on at a clinic visit. You will leak until then.
- Erosion
- A device wearing through the wall of the tube. Uncommon, but the reason an artificial sphincter needs checks over the years, and the reason it is removed if infection sets in.
- Revision
- A further operation to adjust, repair or replace a device.
Commonly believed
Things men tell us, and what is actually true
"Nothing can be done, I have to live with it."
This is what keeps men in pads for years. Lasting leakage after prostate surgery has established treatments with long track records. The first step is an assessment, and asking for it commits you to nothing.
"Another operation means the first one failed."
The prostatectomy was to remove the cancer, and that is judged by your PSA, not by your bladder. Lasting leakage is a known effect of the operation in a minority of men, and treating it is a separate, planned step.
"An implant will set off airport scanners and stop me travelling."
The parts are small and soft and do not usually trigger scanners. You will be given a card describing the device. Men with an artificial sphincter travel, work, swim and cycle. The one rule is to tell any doctor placing a catheter that it is there.
Being straight with you
What this page cannot tell you, and who these do not suit
This page cannot tell you which treatment is right for you, or whether you should have one at all. That decision belongs to you and the team that has assessed you. It can tell you what they weigh: how much you leak, whether the sphincter or the bladder is the problem, whether you have had radiation, your hand function and your other illnesses.
Who each option does not suit
A sling is usually not offered after radiation to the area, or for heavy leakage, because it tends not to hold. An artificial sphincter is not suitable for a man who cannot work the pump, who cannot attend for checks, or whose bladder does not empty. Every option carries a chance of infection, of not working well enough, and of a further operation later.
What to ask your centre
Ask which of these procedures they perform, how many they do each year, and what their own results and revision rates are. Ask what happens if the device fails. Not every centre offers every option, and it is fair to ask for a referral if yours does not.
Costs vary widely between the options and between centres. Aarogyasri, CGHS, ECHS, EHS and cashless insurers each have their own rules on implants, so check your cover before the assessment rather than after. There is no EMI scheme.Questions we are asked
Common questions about treating lasting leakage
How long do I have to wait before a sling or sphincter is offered?
Most surgeons wait until around a year after the prostatectomy, because control keeps improving for that long and many men become dry without a procedure. Assessment and supervised physiotherapy can start earlier.
Is the artificial sphincter operation a big one?
It is a smaller operation than the prostatectomy, done through two short cuts, usually with a stay of a night or two. The main effort comes afterwards: the device is left off for some weeks to heal, then switched on at the clinic, and you learn to use the pump.
Does an artificial sphincter make you completely dry?
Most men with one are dry or use a light pad for safety, and describe a large change in daily life. A few still leak a little with heavy effort. It is not a promise of total dryness. Ask your surgeon for their own results.
Can I have a sling first and a sphincter later if needed?
Yes, that is a common path for men with lighter leakage. A sling that does not hold does not stop a sphincter being placed afterwards. Going the other way is unusual.
I had radiation after my surgery. Does that change the options?
It usually does. Radiation stiffens the tissue around the tube, so slings tend not to work and are often not offered. An artificial sphincter can still be placed, though the chance of problems over the years is somewhat higher.
What happens if the device gets infected?
An infected device usually has to be removed, the area allowed to heal, and a new one placed months later. This is uncommon, and the risk is lowest in men whose diabetes is well controlled, who do not smoke and who report any redness or fever early.
My father is 78. Is he too old for any of this?
Age alone does not rule anything out. What matters is general fitness for a short anaesthetic, whether his hands can work a pump, and whether he can attend for follow-up. The assessment answers this better than his birth year.
Will Aarogyasri or my insurance pay for the implant?
Cover for implants varies a lot between schemes and policies, and the device itself is often the largest part of the cost. Ask the centre's insurance desk to check your specific cover before the assessment starts, and call the helpline with your card details if you want us to look into it with you.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- American Cancer Society — Surgery for prostate cancer
- NHS — Urinary incontinence: treatment
- Cancer Research UK — Surgery for prostate cancer
- Macmillan Cancer Support — Prostate cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
When Does Continence Come Back?The milestones, and when waiting stops being the planUrinary Incontinence After ProstatectomyWhy the leaking happens in the first placePelvic Floor Exercises Before and After ProstatectomyThe training every option starts withPads, Sheaths and Managing LeakageGetting through the wait for assessmentCost, Insurance and Schemes for Cancer SurgeryHow scheme and insurance cover works
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Still in pads a year on?
Tell us how long it has been and how much you leak each day, and we will help you reach a surgical oncologist who can arrange the assessment and explain the options. One helpline serves every CION centre.