Male Urinary Incontinence Melbourne
Urinary incontinence affects a significant proportion of men, most commonly as stress incontinence following prostate surgery, but also due to overactive bladder or neurological conditions. Dr Brendan Dias provides thorough assessment using bladder diaries, pad testing, cystoscopy and urodynamic studies to accurately diagnose the type and severity of incontinence, then guides treatment from conservative pelvic floor physiotherapy through to male sling or artificial urinary sphincter surgery for persistent moderate to severe leakage. Treatment is tailored to the type of incontinence, its severity, and the individual man's goals and dexterity.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Accurate diagnosis of stress versus urge incontinence through urodynamic testing
- Structured conservative pathway with pelvic floor physiotherapy before surgery is considered
- Male sling surgery for effective, minimally invasive treatment of mild to moderate leakage
- Artificial urinary sphincter offering the highest success rates for severe incontinence
- Medical and minimally invasive options (medication, Botox, neuromodulation) for overactive bladder
- High patient satisfaction with modern continence surgery
- Coordinated continence nurse and physiotherapy support throughout treatment
The Procedure
Assessment begins with a bladder diary and pad weight testing to quantify leakage, followed by cystoscopy to examine the urethra and bladder neck, and urodynamic studies to assess bladder function and sphincter competence. Mild to moderate stress incontinence not responding to pelvic floor physiotherapy is treated with a male sling, a supportive mesh placed beneath the urethra through a small perineal incision. Moderate to severe stress incontinence is treated with an artificial urinary sphincter, a hydraulic device with a cuff around the urethra, a pump in the scrotum and a pressure-regulating balloon, allowing voluntary voiding when the patient squeezes the pump. Urge incontinence from overactive bladder is managed with bladder training, medication, botulinum toxin injections or sacral neuromodulation as needed.
Who Is a Candidate?
Men with persistent urinary leakage more than 12 months after prostate surgery despite pelvic floor physiotherapy are candidates for surgical treatment: those using one to four pads per day with predominantly stress leakage are generally suited to a male sling, while those using three or more pads per day, with more severe incontinence, or with prior pelvic radiotherapy, are better suited to an artificial urinary sphincter. Men must have adequate manual dexterity to operate the sphincter pump. Men with predominant urgency and urge incontinence are usually managed medically or with bladder-directed therapies rather than incontinence surgery.
Recovery
Recovery after male sling surgery involves a same-day or overnight stay, with return to desk work in one to two weeks and physical activity resuming over four to six weeks. Artificial urinary sphincter surgery involves a one to two night hospital stay, with the device left deactivated for six weeks to allow healing, then activated in clinic, after which most men notice immediate improvement in continence. Non-surgical treatments for overactive bladder involve ongoing management with periodic review of symptom control and side effects.
Risks & Considerations
Male sling risks include temporary urinary retention, perineal discomfort, infection, and a small risk of mesh erosion or sling failure requiring further treatment. Artificial urinary sphincter risks include infection requiring device removal, mechanical failure over time requiring revision, and urethral erosion, particularly in men with prior radiotherapy. Medical treatments for overactive bladder can cause dry mouth, constipation or, rarely, urinary retention, while botulinum toxin injections carry a small risk of temporary incomplete bladder emptying requiring self-catheterisation.