What is urinary incontinence?
Urinary incontinence is the involuntary loss of urine. Dr. Wiegand's practice focuses primarily on male urinary incontinence — from leakage following prostate surgery or radiation, to overactive bladder and urgency incontinence that can occur independently of prostate treatment.
Many men don't know what type of incontinence they have — and that's normal. The evaluation process is designed to figure that out. Stress incontinence (leakage with activity) and urge incontinence (leakage driven by sudden urgency) are treated very differently, and many men have elements of both. Getting the diagnosis right before choosing a treatment is the foundation of Dr. Wiegand's approach.
You don't have to live with it
Urinary incontinence significantly impacts quality of life — limiting activity, affecting relationships, and causing embarrassment. It is one of the most undertreated conditions in urology. Whether your leakage is stress-related, urgency-related, or mixed, effective treatments exist that can restore normal or near-normal urinary control in the majority of appropriately selected patients.
Understanding the type of leakage matters
Different types of incontinence have different causes and require different treatments. Accurate diagnosis is essential before any intervention.
Stress Incontinence
Leakage with physical activity — coughing, sneezing, lifting, exercise. The most common type after prostate surgery. Caused by a weakened or damaged urinary sphincter.
Urge Incontinence
A sudden, strong urge to urinate followed by involuntary leakage. Often caused by bladder overactivity rather than sphincter weakness. Requires different treatment than stress incontinence.
Mixed Incontinence
A combination of stress and urge incontinence. Common after radiation therapy. Thorough urodynamic evaluation is needed to guide treatment decisions.
Post-Prostatectomy Incontinence
Leakage specifically following radical prostatectomy. Ranges from minimal dribbling to complete loss of control. Severity determines treatment approach.
How is incontinence evaluated?
A careful evaluation determines the type, severity, and underlying cause of incontinence — and rules out conditions such as stricture or bladder dysfunction that could affect treatment choice.
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History & Pad Usage Assessment
Understanding how many pads per day, what triggers leakage, and how it impacts daily life guides treatment planning.
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Urodynamic Studies
Functional testing of bladder storage and emptying. Identifies whether incontinence is due to sphincter weakness, bladder overactivity, or both — critical for selecting the right procedure.
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Cystoscopy
Direct visualization of the urethra and bladder to assess sphincter function, rule out stricture, and evaluate bladder anatomy before any surgical implant.
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Post-Void Residual Assessment
Ultrasound measurement of urine remaining in the bladder after voiding. Identifies incomplete emptying, which can coexist with or mimic incontinence and must be accounted for before planning treatment.
Treatment options for stress incontinence
Stress urinary incontinence — leakage with activity, coughing, sneezing, or lifting — is the most common type after prostate surgery. Treatment ranges from conservative measures early after surgery to highly effective surgical implants for persistent leakage.
Pelvic Floor Therapy
Supervised pelvic floor muscle training (Kegel exercises) with a specialized physical therapist. Most effective when started before prostatectomy and continued afterward. Recommended for all patients in the early post-operative period.
Behavioral Modifications
Fluid management, timed voiding, caffeine and alcohol reduction, weight loss, and constipation management can meaningfully reduce leakage episodes. No side effects — recommended alongside all other treatments.
Artificial Urinary Sphincter (AMS 800)
The gold-standard surgical treatment for moderate to severe male stress urinary incontinence — particularly for patients with more significant leakage, prior radiation, or failed prior surgery. Three components: a urethral cuff, a pressure-regulating balloon, and a scrotal pump the patient squeezes manually to urinate. Approximately 85–90% achieve socially continent status. Dr. Wiegand performs primary implantation and complex revision surgery.
Best for
Moderate to severe SUI · Prior radiation · Failed sling · Requires manual dexterity
Male Urethral Sling (AdVance XP)
A mesh sling placed under the urethra to reposition and support it, restoring resistance to leakage. No device to operate — urination is natural. Best for mild to moderate stress incontinence without prior radiation. Not adjustable after placement. Most patients notice improvement within weeks; full benefit over 1–3 months.
Best for
Mild to moderate SUI · No prior radiation · Patients who prefer no device to operate
ProACT™ Adjustable Continence Therapy (Periurethral Balloons)
Two small fluid-filled silicone balloons placed on either side of the urethra at the bladder neck, gently compressing it to reduce leakage. Volume adjustable in the office after surgery without additional surgery. Outpatient procedure; no device manipulation required to urinate. Lower long-term continence rates than AMS 800; multiple adjustment visits required. Preserves future surgical options.
Best for
Mild to moderate SUI · Minimally invasive preference · Not ideal for sling or AUS · Wants adjustability
Revision & Salvage Surgery
Patients with prior AMS 800 or sling failure, erosion, or infection may require revision surgery. Dr. Wiegand has specialized experience in these complex reoperative cases, including device explantation, urethral reconstruction, and reimplantation after adequate healing.
Treatment options for urge incontinence
Urge incontinence — leakage driven by a sudden, strong urge to urinate — is treated with a stepwise approach. Behavioral therapy comes first, followed by medications, then advanced interventional options for patients who don't respond adequately.
Bladder Training & Behavioral Therapy
Scheduled voiding with gradual interval extension trains the bladder to hold more urine before triggering urgency. Combined with pelvic floor therapy for urge suppression. No side effects — recommended for all patients with OAB as the starting point.
Medications (Antimuscarinics & Beta-3 Agonists)
Antimuscarinic medications reduce involuntary bladder contractions but carry side effects including dry mouth, constipation, blurred vision, and cognitive effects in older adults. Beta-3 adrenergic agonists (such as mirabegron) relax the bladder with fewer cognitive side effects but may mildly raise blood pressure. Neither class is effective for pure stress incontinence.
Intradetrusor Botulinum Toxin (Bladder Botox)
Botox injected directly into the bladder wall reduces involuntary contractions for 6–12 months. An in-office or outpatient procedure. Risks include urinary retention and UTI — some patients may need temporary self-catheterization. Repeat injections required as effect wears off.
Bladder Augmentation
For patients with very small or severely non-compliant bladders that cannot be managed by other means, a segment of bowel is used to surgically enlarge the bladder capacity. Reserved for carefully selected patients in whom all other options have been exhausted.
Urinary Diversion
In exceptional cases where the bladder cannot be salvaged or reconstructed, urinary diversion redirects urine away from the bladder entirely. Options include continent and incontinent diversions depending on patient anatomy and goals. Learn more about urinary diversion →
What to expect after surgery
Detailed instructions for each procedure are provided below. Please follow these carefully and call our office with any concerns.
After Artificial Urinary Sphincter (AMS 800)
Dr. Lucas Wiegand · Florida Reconstructive Urology · (877) 876-3627
Critical Rules
- ⚠️ Never use urethral catheters — can permanently damage the urethra and sphincter; device may need removal and may not be replaceable
- • Do not use penile clamps or condom catheters
- • Wear your medic alert bracelet provided at discharge
- • Keep the Boston Scientific device cards given to you at all times
- • Device is MRI-conditional at 1.5T and 3.0T — imaging centers may request device documentation
Activity & Wound Care
- • Device will be activated at your follow-up visit (not at discharge)
- • Shower starting the day after surgery
- • Do not pick at or remove the glue over incisions
- • Avoid lifting >10 lbs or strenuous activity for 4 weeks
- • Drink a normal amount of fluid
- • Pain medications sent to your pharmacy if needed
Call Our Office If You Have
- • Inability to urinate
- • Wound drainage (send a photo or come in)
- • Fever or signs of infection
- • Severe pain not controlled by medications
After AdVance XP Male Sling
Dr. Lucas Wiegand · Florida Reconstructive Urology · (877) 876-3627
Activity
- • Light activity only for 2 weeks
- • No lifting >10–15 lbs for 4–6 weeks
- • Avoid biking, horseback riding, or pressure on the perineum for 6 weeks
- • No driving for 24 hours or while taking narcotics
- • No sexual activity for 2 weeks
Catheter & Urination
- • Foley catheter stays overnight
- • Return next day for voiding trial and catheter removal
- • Stream may be slower early on — do not strain
- • AZO (OTC) for urinary burning as needed
- • Call if unable to urinate after catheter removal
Pain, Wound & Bowel Care
- • Percocet as prescribed; do not exceed 3,000 mg/day total acetaminophen
- • Avoid NSAIDs for 48–72 hours unless instructed
- • Shower after 24 hours; avoid baths/pools/hot tubs for 2 weeks
- • Bruising and swelling are normal
- • Stool softener (Colace); add Miralax if needed. Hydrate well. Avoid straining.
Call Our Office If You Have
- • Fever >100.5°F
- • Severe pain not controlled
- • Heavy bleeding or clots
- • Rapid scrotal or perineal swelling
- • Inability to urinate after catheter removal
Ready to reclaim your quality of life?
Urinary incontinence is treatable. Dr. Wiegand will evaluate your specific situation and recommend the most appropriate solution.
Request a Consultation