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How to cite: Loh-Doyle JC. Updates in Management of Post-Prostatectomy Incontinence. Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/updates-in-management-of-post-prostatectomy-incontinence/
Summary
Jeffrey C. Loh-Doyle, MD, Assistant Professor of Clinical Urology, University of Southern California, Los Angeles, California, presents an overview of stress urinary incontinence (SUI) management following prostatectomy. He frames modern treatment options within a historical context, showing that while many device concepts are decades old, current practice continues to evolve through refinements in technique, patient selection, and perioperative strategy.
Dr. Loh-Doyle notes that anti-leakage devices have existed for centuries and that the artificial urinary sphincter (AUS) in modern use is largely unchanged from versions developed in the early 1980s. He explains the long-standing role of male slings and describes them as appropriate for mild to moderate incontinence, while noting that severe cases may require a sphincter.
He reviews general counseling principles for patients undergoing prostatectomy and highlights the typical time course for recovering urinary control. He discusses pelvic floor physical therapy as an important component of early management and describes the guideline-based algorithm for selecting interventions depending on prior treatments and symptom severity.
Dr. Loh-Doyle reviews considerations for implanting an AUS, including patient cognitive ability, preferred surgical approaches, and factors that increase risk, such as prior radiation or prior device complications. He outlines strategies for reducing complications, including delayed activation and careful reservoir placement.
Dr. Loh-Doyle emphasizes that although innovation has been slow historically, new devices are emerging and may influence future management.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
