Problems with Artificial Urinary Sphincter (AUS) install: Tips?

Good news about the AUS! Glad to hear it is working so well for you!!!!

What does AUS mean?

@billbale
Artificial urinary sphincter. It’s a device they put around your urethra That closes it off, so urine doesn’t leak until you pump a little bulb to reverse the blockage.

If you look it up on the web, you’ll find the devices.

@billbale, it can be frustrating when members sling around acronyms without providing the spelled out full name. That's why the members created this handy list.

- Prostate cancer-related abbreviations: What acronym would you add?https://connect.mayoclinic.org/discussion/prostate-cancer-related-abbreviations-what-acronym-would-you-add/

You can bookmark the list for future reference.

To everyone: Please spell out abbreviations, expecially when opening a discussion. Sometimes abbreviations are necessary to fit the title into the 70 charater limit, but you can spell it out in the first message. Thanks for helping new members.

Thank you so much !

Thank You!
Bill

TL;DR:
After RALP in February 2025, I developed complete urinary incontinence despite having previously managed a neurogenic bladder successfully with clean intermittent catheterization (CIC) for 16 years. A bone-anchored sling in October improved things but did not stop leakage. In December 2025, I underwent ProACT implant surgery. After my first balloon adjustment in January 2026, the improvement has been dramatic—I am now essentially dry, using only a light shield for occasional drops. After 11 months of severe incontinence, ProACT has provided meaningful, life-changing relief.
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This is an update on my experience with ProACT implants for the treatment of urinary incontinence. I’ll start with a brief recap for context.

I underwent RALP on 2/10/25, with nerve-sparing intent. Prior to surgery, I had a neurogenic bladder resulting from a spinal cord injury 16 years earlier. Since that injury, I had successfully managed my bladder with clean intermittent catheterization (CIC), with no leakage at all between catheterizations. I was advised to expect a period of stress incontinence after surgery.

Unfortunately, the outcome was far worse than expected. The surgery resulted in complete incontinence—and I truly mean complete. My bladder simply drained continuously into disposable underwear, which I had to change 7–8 times per day to prevent leakage. I eventually transitioned to wearing an external male catheter 24/7 (Men’s Liberty from BioDerm).

I then consulted a urologist who specializes in incontinence. After urodynamic testing, we decided to try a bone-anchored mesh sling as a first—and hopefully final—step. I technically “failed” the urodynamics study, but the goal of the sling was modest: to get me back to a point where CIC would again be feasible. I was completely comfortable with that plan, having successfully used CIC for 16 years in a demanding, travel-heavy work environment.

I was skeptical that the sling would fully resolve my incontinence—and, as it turned out, I was right. An artificial urinary sphincter (AUS) was my least preferred option due to relatively high revision rates and concerns about compatibility with cycling, which is my primary form of exercise and recreation.

On 10/13/25, I underwent sling surgery. While it didn’t solve the problem, it did change things significantly. For the first time in eight months, I found myself needing to catheterize again—though I was still experiencing substantial leakage. I began using Tena Men Maximum absorbent guards, which I highly recommend.

As I researched next steps, I learned about ProACT implants. It turned out my urologist was one of only a handful on the East Coast trained and experienced with this procedure. When I asked why he hadn’t mentioned it earlier, he explained that my private insurance did not typically cover it (although Medicare does). My wife asked him to submit a coverage request anyway, given my complex medical history. I’m Medicare-eligible but still insured through my wife’s employer, and I made it clear I would switch to Medicare if necessary.

To our complete surprise, BCBS Illinois approved the procedure quickly. We later learned that BCBS Michigan had previously been compelled to cover ProACT following an arbitration case brought by a forum member—apparently influencing broader BCBS coverage decisions.

On 12/1/25, I had the ProACT implant surgery. It was still performed under general anesthesia, but my urologist described it as minimally invasive compared with sling or AUS surgery. The balloons were initially filled with only a small amount of fluid to allow healing and proper implant seating. I was instructed not to lift more than 10–15 pounds for at least a month, which I strictly followed.

The first postoperative week involved almost no leakage, largely due to swelling (similar to what I experienced after sling surgery). As the swelling subsided, leakage gradually returned, and I was using 3–5 heavy pads per day.

One week ago—on 1/6/26—I had my first ProACT adjustment. My urologist added 1.5 cc of fluid to each side, bringing the total to 2.5 cc out of a possible 8 cc per balloon. The improvement has been nothing short of dramatic. I intentionally waited a full week before writing this update, worried the effect might be temporary—but it hasn’t been.

At this point, I am practically completely dry. I still wear a light Depends shield to catch an occasional drop, but by the end of the day the pad weighs only 3–4 grams more than a new one. I consider this a complete win. I don’t regret the sling surgery at all; I believe it’s contributing to the overall effectiveness of the ProACT implants.

The final test will be returning to cycling once the weather improves. I can feel the access ports under the skin of my scrotum, but I use a saddle with a center cutout, so I’m hopeful this won’t be an issue.

The past 11 months have been an absolute nightmare of incontinence. I am profoundly grateful to have finally found meaningful relief. I’ll continue to update if anything changes.