Men’s Reconstructive Urology · University Urology, PC

Male Urinary Incontinence

Urinary leakage after prostate surgery or radiation is common — and very treatable. We offer a complete range of options from conservative management to male sling and artificial urinary sphincter surgery, performed by a fellowship-trained reconstructive urologist.

Request a Consultation Call (865) 305-9254
Fellowship-Trained Reconstructive Urology
Male Sling & AUS Surgery
Post-Prostatectomy Incontinence
Only Fellowship-Trained Reconstructive Urologist in the Region

Understanding the Condition

Male Urinary Incontinence

Male urinary incontinence is the unintentional leakage of urine. It can range from mild — occasional leakage with activity — to severe, with frequent leakage requiring multiple pads per day. Many men develop symptoms after prostate surgery, radiation, or other pelvic procedures.

Incontinence is underreported and undertreated, in part because many men assume it is an inevitable consequence of prostate treatment. It often is not. Effective, durable solutions exist for most men — the key is identifying the type and severity of leakage and matching the right treatment to your specific situation.

A clear diagnosis matters because treatments differ depending on whether leakage is stress-related, urgency-related, or a combination of both. Our evaluation is designed to identify the cause and give you a plan.

When to Get Evaluated

  • Leakage affecting quality of life, travel, sleep, or exercise
  • Using multiple pads per day
  • Persistent leakage beyond the early recovery period after prostate treatment
  • Recurrent skin irritation or infections related to leakage
  • Uncertainty about what is “normal” after prostate surgery or radiation

Types of Male Incontinence

Not All Leakage Is the Same

Stress Urinary Incontinence (SUI)

Leakage that occurs with physical exertion — coughing, laughing, lifting, standing up, or exercise. The most common type after prostatectomy. Results from weakened sphincter function. Responsive to sling and AUS surgery.

Urgency Urinary Incontinence

Leakage associated with a sudden, strong urge to urinate that cannot be deferred. Often related to bladder overactivity rather than sphincter weakness. Managed differently — typically with behavioral therapy, medications, or neuromodulation.

Mixed Incontinence

Both stress and urgency components present simultaneously. Requires careful evaluation to determine the predominant mechanism before selecting treatment. Surgery alone may not fully address the urgency component.

Post-Void Dribbling

Leakage of small amounts of urine immediately after finishing urination. Common and often managed with simple behavioral techniques. Distinct from stress or urgency incontinence.

Evaluation

How We Evaluate Male Incontinence

We start with a thorough history and targeted testing to identify the cause and severity of leakage before recommending any treatment. What to bring helps us get more out of your first visit.

What We Review at Your Visit

  • Detailed symptom history — pad use, triggers, urgency, nighttime frequency
  • Prior prostate treatment history — surgery type, radiation, timing
  • Medication review for contributing factors
  • Urinalysis and post-void residual (PVR) measurement
  • Cystoscopy when indicated to assess urethral and bladder anatomy
  • Urodynamic testing for complex or mixed symptoms

What to Bring

  • Current medication list
  • Prior operative report from your prostatectomy if available — this directly informs surgical planning
  • Radiation treatment summary if applicable
  • A note on average daily pad use and what triggers your leakage
  • Any prior incontinence treatments or devices tried

Treatment Options

Treatment Is Individualized — We Start With the Right Fit

We consider the type of leakage, severity, your anatomy, prior treatments, and personal preferences before recommending any procedure. Conservative options are reviewed first when appropriate.

Conservative

Behavioral & Conservative Management

First-line strategies that can meaningfully reduce leakage for many men, especially those with mild symptoms or urgency-predominant incontinence.

  • Pelvic floor muscle training (Kegel exercises)
  • Bladder diary and fluid management
  • Timed voiding and urge suppression techniques
  • Medication for urgency or overactive bladder
  • Absorbent products and skin protection guidance
Surgical

Male Urethral Sling

A minimally invasive surgical option for men with mild to moderate stress urinary incontinence. A soft mesh sling is placed to reposition and support the urethra, improving closure during activity.

  • Outpatient procedure, typically under general or spinal anesthesia
  • No external device or manual pump required
  • Best candidates: mild to moderate SUI, adequate sphincter function remaining
  • Recovery: return to light activity within 1–2 weeks
  • Not recommended for severe incontinence or prior radiation in some cases
Surgical

Artificial Urinary Sphincter (AUS)

The gold-standard surgical treatment for moderate to severe male stress urinary incontinence. An implanted device that allows voluntary control of urination via a scrotal pump.

  • Inflatable cuff placed around the urethra; pump in scrotum; reservoir behind pubic bone
  • Patient squeezes pump to temporarily open cuff and urinate
  • Durable with high long-term satisfaction rates
  • Effective even after radiation therapy
  • Revision may be needed over time — discussed at consultation
Procedural

Sacral Neuromodulation (Axonics)

For men with urgency urinary incontinence or mixed symptoms with a dominant urgency component. A small implantable device modulates the sacral nerves to reduce urgency and frequency.

  • Peripheral nerve evaluation (PNE) trial performed first in-office
  • Permanent implant placed if trial successful
  • MRI-compatible device; rechargeable options available
Procedural

Botox (OnabotulinumtoxinA)

In-office or outpatient bladder injection for urgency-predominant incontinence that has not responded to medications. Reduces involuntary bladder contractions.

  • Performed cystoscopically under local anesthesia
  • Effects last 6–9 months; repeat injections needed
  • Requires monitoring for urinary retention afterward
Post-Surgical

Penile Clamp & External Devices

Temporary aids used during recovery or while awaiting surgery. Not a long-term solution but can reduce pad burden in the interim.

  • External urinary collection systems
  • Penile compression clamps (short-term use only)
  • Discussed as a bridging option when appropriate

Surgical Options in Detail

Male Sling & Artificial Urinary Sphincter — What to Expect

Both procedures are performed by Dr. John Lacy, the region’s only fellowship-trained male reconstructive urologist. The right choice between them depends on the severity of your incontinence, prior radiation history, and anatomical factors reviewed at your consultation.

Who Is a Candidate for Sling

  • Mild to moderate stress urinary incontinence
  • Primarily activity-related leakage (not constant)
  • No prior radiation in most cases
  • Adequate intrinsic sphincter function remaining
  • Desire to avoid a device with a pump mechanism

Who Is a Candidate for AUS

  • Moderate to severe stress urinary incontinence
  • Post-prostatectomy or post-radiation incontinence
  • Failed or inadequate response to sling
  • Willing and able to operate a scrotal pump
  • Preferred for men with severe leakage regardless of radiation history

Recovery & Expectations

  • Both procedures are typically outpatient
  • AUS: device activated 4–6 weeks after surgery to allow healing
  • In-office training on AUS pump use before activation
  • Significant pad reduction expected for appropriately selected patients
  • Realistic goals and outcomes reviewed in detail at consultation

Insurance & Authorization

  • Both procedures are covered by Medicare and most commercial insurance
  • Prior authorization typically required
  • Documentation of conservative treatment failure may be needed
  • Our team assists with authorization and pre-op coordination

From Dr. Lacy

Male Incontinence — Causes & Treatment Options

Dr. John Lacy explains the causes of male urinary incontinence and the modern surgical options available — including the male sling and artificial urinary sphincter. A helpful overview before your consultation.

Request a Consultation Call (865) 305-9254

Your Surgeon

Reconstructive Urology at University Urology

Male sling and AUS procedures require subspecialty training to perform well and manage long-term. Dr. Lacy is the only fellowship-trained male reconstructive urologist in East Tennessee.

JL

Dr. John M. Lacy, MD

Fellowship-Trained Male Reconstructive Urology · Only in East Tennessee

Dr. Lacy’s practice is focused on male reconstructive urology — urethral stricture, urethroplasty, artificial urinary sphincter, male urethral sling, inflatable penile prosthesis, and post-prostatectomy incontinence. He sees patients at UTMC (Knoxville), Lenoir City, and Crossville.

Full Profile →

Frequently Asked Questions

Common Questions About Male Incontinence

How long after prostatectomy should I wait before seeking treatment for incontinence?
Most men experience some degree of incontinence immediately after prostatectomy, and natural recovery continues for up to 12–18 months. We generally recommend waiting at least 12 months before proceeding with surgical correction — both to allow maximum natural recovery and to ensure the incontinence has stabilized. However, an early evaluation helps us track your progress, guide pelvic floor exercises, and have a plan ready if surgery is ultimately needed.
Is the AUS the right choice for everyone with post-prostatectomy incontinence?
Not necessarily. Men with milder leakage — one to two pads per day — may be excellent candidates for a male urethral sling, which is less complex and does not require a pump. Men with severe leakage, or those who have had radiation therapy, are typically better served by the AUS. The decision is made together based on your specific history, anatomy, and preferences at consultation.
Does radiation affect candidacy for surgery?
Yes, prior radiation can affect both tissue healing and surgical outcomes. Men who have had radiation generally are not ideal candidates for a male sling but can still be very good candidates for AUS, which has demonstrated effectiveness even in the post-radiation setting. Radiation history is an important part of our evaluation and surgical planning.
Will the AUS need to be replaced?
AUS devices are durable but not permanent. Mechanical failure, erosion, or infection can require revision surgery in a minority of patients over time. Modern devices have improved reliability significantly. We discuss realistic long-term expectations at your consultation, including how revision procedures are handled if ever needed.
Does insurance cover AUS or sling surgery?
Both procedures are covered by Medicare and most commercial insurance plans when medically indicated. Prior authorization is typically required, and documentation of incontinence severity and conservative treatment may be needed. Our team assists with the authorization process and pre-operative coordination.
Can incontinence after radiation be treated?
Yes. Post-radiation incontinence is often more complex to manage than post-surgical incontinence, but effective treatment is available. AUS is the most reliable surgical option for men with significant leakage after radiation. Conservative measures and neuromodulation can also help manage urgency-predominant symptoms. A thorough evaluation determines the best approach for your specific situation.

Ready to Take the Next Step?

Incontinence after prostate treatment is common — and very treatable. We’ll build a plan that’s right for your situation.

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Preparation Instructions

Preparing for Your Procedure

Depending on your scheduled treatment, review the appropriate preparation instructions below.

In-Office Procedure

Bladder Botox Preparation

Arrive with a full bladder. Antibiotic required. Driver recommended.

View preparation instructions → In-Office Procedure

Axonics PNE Trial Preparation

Voiding diary required. No MRI during trial. Driver required.

View preparation instructions → In-Office Procedure

Urodynamics Study (UDS) Preparation

Bladder diary 48 hours before. Arrive with a full bladder.

View preparation instructions →

Having a sacral nerve stimulator implant at UTMC? See Sacral Nerve Stimulator Preparation.