An artificial sphincter is a surgically implanted device that mimics the job of a natural sphincter muscle, squeezing a tube in the body (usually the urethra or the anal canal) shut to prevent leakage. The most common version treats urinary incontinence, particularly in men who leak urine after prostate surgery. A less common version exists for severe fecal incontinence. Both work on the same basic principle: a fluid-filled cuff wraps around the problem area and keeps it closed until you’re ready to go.
How the Device Works
The artificial urinary sphincter has three connected parts, all implanted beneath the skin. A small cuff wraps around the urethra near the bladder neck. A pressure-regulating balloon sits in the lower abdomen. And a control pump is placed in the scrotum for men or the labia for women. These three components are linked by thin tubing, and fluid circulates between them.
In its resting state, the cuff is inflated with fluid, pressing the urethra closed so urine can’t leak out. When you need to urinate, you squeeze the pump a few times with your fingers. This moves fluid out of the cuff and into the balloon, releasing pressure on the urethra so urine can flow. Within one to two minutes, the cuff automatically refills and seals the urethra again. No batteries, no electronics. The whole system runs on hydraulic pressure.
Who Gets One
The artificial urinary sphincter is most often placed in men dealing with stress urinary incontinence after prostate cancer surgery. When the prostate is removed, the internal sphincter that normally helps hold urine in place is often damaged or weakened. For many men, leakage improves on its own within the first year. When it doesn’t, and less invasive treatments like pelvic floor exercises or a male sling haven’t worked, an artificial sphincter becomes the next step. The median age of men undergoing this surgery is 71.
Women can also receive the device, though it’s far less common. In rare cases, the device is used for incontinence caused by neurological conditions or congenital abnormalities rather than surgical damage.
The Bowel Version
A modified version of the same device exists for people with severe fecal incontinence, typically those with large or completely disrupted anal sphincter muscles. The artificial bowel sphincter uses the same three-part design: a cuff placed around the anal canal through two small incisions, a pressure-regulating balloon in the pelvis, and a pump in the scrotum or labia. The first bowel version was actually a urinary device adapted for the anal canal in 1987, and later models were redesigned to better fit that anatomy.
This device is reserved for the most severe cases. Candidates have usually already tried nerve stimulation therapy or other interventions without success. People with very short or damaged tissue in the area between the anus and genitals may not be good candidates because of higher erosion risk.
What Surgery Involves
For the urinary version, the procedure is done under general anesthesia and typically takes one to two hours. The surgeon makes an incision in the perineum (the area between the scrotum and anus) to access the urethra and wrap the cuff around it. A second incision, usually in the groin area, allows placement of the pressure-regulating balloon deep behind the abdominal wall. The pump is then guided into the scrotum through the same groin incision.
Surgeons often follow a “no-touch” technique, covering the skin with sterile sheets and minimizing how much the device components contact anything before implantation. This reduces the risk of introducing bacteria. The cuff is positioned carefully so you won’t be sitting on it, which matters for long-term comfort and durability.
Recovery and Activation
The device is not turned on right away. Your urethra needs time to heal around the cuff, so the sphincter stays deactivated for six to eight weeks after surgery. During this period, you’ll still experience incontinence, which can be frustrating but is expected. A follow-up visit around the two-week mark checks how you’re healing, and the device is activated at the six-to-eight-week appointment.
Once activated, your care team will teach you how to locate the pump and squeeze it properly. Most people get comfortable with the routine quickly. The squeeze-and-wait cycle becomes second nature: press the pump, urinate, and let the cuff refill on its own.
How Well It Works
Success rates are high. In a long-term study of 121 men who received the device after prostate surgery, 87.6% still had the sphincter in place at their last follow-up and reported adequate continence, defined as using no more than one pad per day. Nearly 68% were completely dry with no pads at all. These are strong results for a population that was dealing with significant daily leakage before the procedure.
That said, “success” doesn’t always mean perfection. Some men still use a thin liner for security even though they rarely leak. The goal is functional dryness: getting through a normal day without urine leakage affecting your activities or confidence.
How Long It Lasts
An artificial sphincter is a mechanical device, and like all mechanical devices, it can eventually wear out. Studies show the device has a revision-free survival rate of about 76% at five years, meaning roughly three out of four patients haven’t needed any additional surgery within the first five years. At 15 years, that number drops to around 56%.
When revisions are needed, the median time to the first one is about 19 months, though this varies widely. Some devices last well over a decade. The good news is that revision surgery to replace a worn component is generally straightforward, and many patients go through two or even three devices over their lifetime.
Risks and Complications
The most significant risks are infection, cuff erosion, and mechanical failure. Infection rates range from roughly 0.5% to 7% across published studies. Cuff erosion, where the cuff gradually wears through the urethral tissue it wraps around, occurs in 3.8% to 10% of cases. Overall, about 31% of patients require a second surgery at some point for reasons including infection, erosion, device malfunction, tissue thinning under the cuff, or the pump shifting out of position.
Erosion and infection are the most serious complications because they typically require removing the entire device, letting the area heal for several months, and then implanting a new one. Mechanical failures, like a leak in the tubing or a pump that stops working, are less urgent and can often be repaired by replacing just the broken component.
Certain factors increase risk. Prior radiation therapy to the pelvis makes tissue more fragile and more prone to erosion. Diabetes and obesity can slow healing and raise infection risk. If you’ve had a previous device removed due to erosion, the chances of it happening again with a replacement are higher.