ProACT vs AUS: Which Surgery Is Best for Male Urinary Incontinence?

Male stress urinary incontinence (SUI) can be frustrating and life-changing. Many men experience leakage after prostate surgery or other procedures. If you are dealing with this condition, you are not alone—and there are effective treatments available.

Two common surgical options are the ProACT system and the Artificial Urinary Sphincter (AUS). This article explains both options in simple terms to help you understand your choices and talk with your care team.

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What Is Male Urinary Incontinence After Prostate Surgery?

Stress urinary incontinence happens when urine leaks during activities that put pressure on the bladder. This can include:

• Coughing
• Sneezing
• Lifting
• Exercising

In men, SUI most often occurs after prostate surgery. It happens because the muscles that control urine flow are weakened or damaged.

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What Treatments Are Available for Male Urinary Incontinence?

Treatment depends on how severe your symptoms are. Options may include:

• Pelvic floor exercises
• Medications (in some cases)
• Surgical treatments

When symptoms are moderate to severe, surgery is often the most effective option.

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What Is ProACT and How Does It Work?

The ProACT (Adjustable Continence Therapy) system uses two small balloons placed near the urethra (the tube that carries urine out of the body).

How it works

• The balloons gently press on the urethra
• This helps prevent urine leakage
• The balloons can be adjusted over time to improve control

Benefits of ProACT

• Minimally invasive procedure
• Adjustable after surgery without major procedures
• No need to operate a device manually

Limitations

• May not work as well for severe leakage
• Some men may need adjustments over time
• Not suitable for all patients

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What Is an AUS (Artificial Urinary Sphincter) and How Does It Work?

The AUS is considered the gold standard treatment for moderate to severe male SUI.

How it works

The AUS has three parts:

• A cuff placed around the urethra
• A small pump placed in the scrotum
• A fluid-filled balloon in the abdomen

When the cuff is closed, it prevents leakage. To urinate, you press the pump, which opens the cuff temporarily.

Benefits of AUS

• Highly effective for moderate to severe incontinence
• Long track record of success
• Can significantly improve quality of life

Limitations

• Requires manual use (pressing the pump)
• More complex surgery than ProACT
• Small risk of infection or mechanical failure over time

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ProACT vs AUS: How Do You Choose the Right Surgery?

Choosing between ProACT and AUS is a personal decision. This simple guide can help you think through what may fit your needs best.

You may prefer ProACT if you:

• Have mild to moderate leakage
• Want a less invasive procedure
• Prefer not to operate a device manually
• Like the option of adjustments after surgery

You may prefer AUS if you:

• Have moderate to severe leakage
• Want the most effective, long-term solution
• Are comfortable using a small pump to urinate
• Have not had success with other treatments

Many patients find it helpful to discuss these questions with a specialist to make the best choice for their lifestyle and goals.

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Which Surgery Is Right for You?

The best treatment depends on your specific condition, lifestyle, and preferences. Your care team may consider:

• Severity of leakage
• Prior treatments or surgeries
• Overall health
• Ability to use a device

Some men prefer ProACT because it does not require manual use. Others choose AUS for its higher success rates, especially in more severe cases.

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What Is Recovery Like After ProACT or AUS Surgery?

Recovery times vary, but most men can return to normal activities within a few weeks.

• ProACT adjustments may be needed after surgery
• AUS devices are usually activated several weeks after placement

Your care team will guide you through recovery and follow-up care.

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When Should You See a Specialist for Male Incontinence?

You should consider seeing a specialist if:

• Leakage continues after prostate surgery
• Symptoms affect your daily life
• You are using pads regularly

Early evaluation can help you find the right treatment sooner.

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Ready to Talk About Treatment Options?

If you are dealing with male stress urinary incontinence, effective treatments are available. A consultation with a urologist can help you understand your options and choose the best path forward.

At Mayo Clinic, urologists Dr. Katie Anderson and Dr. Nick Warner offer both ProACT and artificial urinary sphincter procedures. They work closely with patients to find the treatment that best fits each person’s needs and goals.

Request an appointment today to learn more about your treatment options and take control of your quality of life.

Helpful Links

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