Prof. Dr. Emel Akoğlu
UrologyVerified
- 57+years exp.
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Kidney & Bladder
Artificial urinary sphincter implantation
What an artificial urinary sphincter is, how the cuff, balloon and pump hold back urine, what the evidence says about dryness after prostate surgery, how it compares with male slings and bulking agents, approximate costs in Turkey against the UK, US and Germany, recovery, device risks and how to choose a urology team.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Artificial urinary sphincter implantation: what it is and how it works
Artificial urinary sphincter implantation is an operation that places a small, fluid-filled device in the body to keep the urethra closed until you choose to pass urine. It is used for moderate to severe stress urinary incontinence, which means leaking when you cough, lift, walk or stand, most often in men whose own sphincter muscle was damaged by prostate surgery or radiotherapy. The device has three parts joined by tubing: a cuff that fits around the urethra, a pressure-regulating balloon placed in the lower abdomen, and a small pump in the scrotum (or labia in women). At rest the cuff is full and squeezes the urethra shut. When you want to pass urine you press the pump, fluid moves from the cuff to the balloon, the urethra opens and the bladder empties. The cuff then refills slowly by itself.
This guide explains who the device suits, what the evidence says, what it costs compared with the UK, US and Germany, how the operation and recovery go and how to check a clinic. Hospitals in Turkey perform this surgery within the wider field of urology treatments in Turkey.
Who needs an artificial urinary sphincter?
The usual patient is a man with persistent leakage that has lasted at least six to twelve months after a radical prostatectomy, a transurethral prostate operation or pelvic radiotherapy, and who has not improved with pelvic floor exercises. Less common causes include spinal injury, congenital bladder problems and previous urethral surgery. Women with stress incontinence are normally offered other operations first, and sphincter implantation in women is done in only a few specialist centres.
Leakage is usually graded by pad use: one or two pads a day is mild, and several pads a day or a constant leak is severe. A sphincter is generally considered when leakage is bothersome or severe and when the problem is the closing muscle rather than an overactive bladder, which needs different treatment.
Does an artificial urinary sphincter work? What the evidence says
It is the most thoroughly documented surgical treatment for severe male stress incontinence, and European and American urology guidelines recommend it for moderate to severe leakage after prostate surgery. Many men report using no pads or one safety pad a day and a clear improvement in quality of life. It does not give normal bladder function: some men still have occasional leaks, and the device cannot help an overactive bladder, a bladder that does not empty or leakage from a urethral stricture. Long-term studies show that devices wear out, so some men need a revision or replacement years after the first operation. Be wary of a clinic that promises complete dryness.
Before surgery a urologist should confirm the cause with a history, a pad test or diary, a urine flow test and a cystoscopy (a camera check of the urethra and bladder), and usually urodynamic studies. Without this work-up the wrong operation may be offered.
How is the sphincter placed? The operation step by step
- Preparation. A urine culture is checked and any infection is treated. Skin is cleaned and antibiotics are given before the first cut.
- Anaesthesia. General or spinal anaesthesia is usual.
- Cuff. Through a small cut in the perineum (between the scrotum and anus), the surgeon frees a section of the bulbar urethra and wraps the cuff around it. A smaller cuff or a transcorporal placement may be chosen if the tissue is thin or has been irradiated.
- Balloon and pump. A second cut in the lower abdomen or groin lets the surgeon place the balloon next to the bladder. The pump is placed in the scrotum, and the three parts are joined by tubing.
- Locking. The device is usually deactivated, or locked, after surgery so the tissues can heal.
The operation takes about 60 to 90 minutes. The device is not activated yet, so you are expected to leak or use a catheter briefly while the area heals.
Artificial urinary sphincter implantation cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges, not hospital quotes. The main cost driver is the device itself, which is imported and priced by the manufacturer, plus the hospital stay and surgeon. Each hospital confirms its price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €8,000 – €17,000 |
| United Kingdom | €12,000 – €25,000 |
| United States | €20,000 – €55,000 |
| Germany | €12,000 – €24,000 |
What changes the price: the device model and number of cuffs, the length of hospital stay, previous surgery that makes the operation harder, and the follow-up visit for activation. A package normally includes pre-operative tests, the device, the operation and anaesthetist, the stay, medication and transfers. Ask whether the activation visit and any early device problem are covered, and in what period.
Artificial sphincter, male sling or bulking agent: which is right?
The alternatives differ in how strongly they treat leakage, and the choice depends on how severe it is and whether you have had radiotherapy.
| Option | Suited to | Typical limits |
|---|---|---|
| Artificial urinary sphincter | Moderate to severe leakage, including after radiotherapy | Mechanical device; may need revision; infection or erosion risk |
| Male sling | Mild to moderate leakage with some sphincter function | Less effective in severe leakage or after radiotherapy |
| Urethral bulking agent | Mild leakage, or patients unfit for larger surgery | Effect often temporary; repeat injections |
Pelvic floor physiotherapy and weight and fluid management are first-line and should be tried before surgery. If you are also thinking about other genital or implant surgery for appearance, note that those operations are separate: the sphincter treats leakage only, unlike penis enlargement, and it does not treat erectile problems. A man who needs both a sphincter and a penile prosthesis should discuss the order with the surgeon.
Who is a good candidate, and who is not?
Good candidates are adults with confirmed stress incontinence, a bladder that stores and empties normally, good hand function to operate the pump, and a urethra free of untreated stricture. You may be unsuited if you have active infection, an unstable bladder that needs treating first, uncontrolled diabetes, severe cognitive impairment or hand weakness that prevents you using the pump, or a bladder cancer that needs treatment. Minor genital operations such as circumcision are normally done separately, not in the same sitting, to keep the area clean around the implant. Men with prior radiotherapy can still have the device, but the risk of erosion is higher and the surgeon must explain it.
Recovery after artificial urinary sphincter implantation
Most men stay one to three nights, sometimes with a catheter for a short time. Expect pain, bruising and swelling in the perineum and scrotum for one to two weeks; avoid heavy lifting, cycling and strenuous exercise for about six weeks. The device is activated at a follow-up visit, typically four to six weeks after surgery, when you are taught to use the pump. Learning to cycle the device takes some days. Because activation needs a second appointment, many patients from abroad either stay in Turkey for several weeks or arrange the activation visit with a urologist at home who is familiar with the device. Agree this plan in writing before you travel.
Your trip to Turkey: how many days do you need?
Plan for about five to seven nights: tests and consultation, surgery, a night or two in hospital, and checks of the wound before the flight. A second trip, or a local arrangement, covers the activation visit. Short flights are usually allowed once the surgeon has checked you, but sitting for long can be uncomfortable, so bring a cushion and walk regularly.
Risks and complications
Recognised risks include infection of the device, which may need removal; erosion of the cuff into the urethra; mechanical failure or leakage of fluid; urethral atrophy, where the tissue under the cuff thins and leakage returns; urinary retention; and pain or scrotal swelling. Infection and erosion are most often reported in men with prior radiotherapy, diabetes or earlier urethral surgery. The device is designed for use over years rather than a lifetime, and revision surgery is not unusual. Professional bodies such as the European Association of Urology, the American Urological Association and the NHS advise a full work-up, a surgeon who does the operation regularly and long-term follow-up. Tell your doctor immediately about fever, severe pain, redness or discharge, or if you cannot pass urine.
How to choose a urologist and hospital, and red flags
Check that the surgeon is a urologist registered in Turkey who performs sphincter implants regularly, that the hospital has an operating theatre and intensive-care facility, and that you receive a written plan and price. Red flags include offering the operation without urodynamic assessment, promising total dryness, a quote with no breakdown, no plan for activation and no arrangement for infection or device problems after you go home. Read how our process works, and request a written plan through our free quote page.
Questions to ask the clinic:
- Which device and cuff size will you use, and what is its warranty?
- Do you advise urodynamics or cystoscopy before surgery?
- Who activates the device, when, and where?
- What happens if the device becomes infected or fails after I fly home?
- How many of these operations does the surgeon do each year?
Hospitals with Urology in Turkey
Frequently asked questions
It is a fluid-filled implant with a cuff around the urethra, a balloon in the lower abdomen and a pump in the scrotum. The cuff keeps the urethra closed, and squeezing the pump lets you pass urine on demand.
For moderate to severe stress incontinence, especially after prostate surgery, it is well supported by guidelines, and many men use no pads or one a day. It does not guarantee complete dryness and cannot treat an overactive bladder.
Approximate ranges are €8,000 to €17,000 in Turkey, against about €12,000 to €25,000 in the UK. The price depends mostly on the device, the hospital stay and any extra tests; the hospital confirms its price in a written quote.
Expect one to three nights in hospital, one to two weeks of soreness and swelling, and no heavy lifting for about six weeks. The device is activated four to six weeks after surgery.
You are under anaesthesia during the operation. Afterwards the perineum and scrotum are sore and bruised for one to two weeks, which painkillers usually control.
Devices are built to last for years, but they can wear out, leak or lose effect as tissue thins. Some men need a revision or replacement, so long-term follow-up matters.
The main risks are infection, erosion of the cuff into the urethra, mechanical failure, tissue thinning and urinary retention. These are more likely after radiotherapy, in diabetes or after earlier urethral surgery.
A sling suits mild to moderate leakage with some sphincter function. A sphincter is usually chosen for moderate to severe leakage or after radiotherapy. A urologist decides after urodynamic testing.
It is possible but uncommon, and women are usually offered other operations first. It is performed in a few specialist centres, so ask how often the surgeon does it.
Plan for about five to seven nights for tests, surgery and wound checks. The activation visit four to six weeks later needs a second trip or a local urologist at home.
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