Can anyone share their experience with ProACT (an AUS)?

@heidenjd25
thank you for the reply, I’m almost 2 years out from surgery and use a couple of depends a day like you depending on fluid intake and access to restrooms. I’m hoping that the Pro Act can help reduce my stress incontinence and great to hear that Dr. Flynn gets high marks!

@1fitgolfer
Once he gets your fluid level in the balloons to a satisfactory level for you (everyone is different) you should be able to get rid of the depend and move to guards I use from Sam’s Club members mark male inconvenience guards (buy case) they are great. I’m now 3 years out and from radical prostatectomy and 1/1/2 from balloons placement. I’m at the fullest level of fluid that Dr Flynn will allow and I have some leakage but not terrible. Very manageable.

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.

Update: took the bike out for a short (5 mile ride) a couple days ago and all went well, its now too cold here in Virginia to do more. I'm now a couple weeks out from my first balloon adjustment and still doing well with maybe 5-10 ml leakage throughout the day even when doing fairly active walking and hoisting my one year old grandson about. Next followup with urologist in about 3 weeks, I'll be asking for a little more volume in the balloons but my current state is light years ahead of where I've been for almost the whole last year.

I’m three weeks post Pro Act implant and I must be healing. As the swelling subsides my incontinence is getting worse. The Dr. did say it would get worse before it gets better. I’m up to 3 pads a day and I don’t feel like my pelvic floor is contracting enough to slow the flow. My first adjustment will be in early April and then another is scheduled for early May. I’m hoping that the balloon inflation does the trick and I can return to normal continence.

@jeffmarc Just a word of warning regarding the ProAct: it’s data is mixed at best and especially in men who’ve had radiation it should not be routinely used. It doesn’t mean it shouldn’t be used but the surgeon must fully explain to the potential patient the very real risk of it not working well in someone who has had radiation. The problem is most surgeons do not have a large experience dealing with radiated patients and, therefore, patients often receive less than informed advice.

Dr. DS Elliott

@elliottdaniel
I saw an Online conference with a urologist that started to use ProACT on all of his Patient with urinary incontinence problems. He talked about the problem with people that had radiation in the past. He found out that those people had real problems with ProACT. Turns out the urethra is hardened by radiation and so the ProACT balloons don’t work properly.

Every time I have recommended ProACT On this forum, I have mentioned that if they have had radiation or may have it in the future, that is not a good option.