Postprostatectomy incontinence (PPI) reduces quality of life, yet remains undertreated despite effective surgical options. Persistently low intervention rates in Europe for PPI suggest a care gap. This study assessed patients' knowledge of surgical PPI treatments and barriers to treatment uptake.
Cross-sectional baseline analysis of ProKontinenz trial. Men with persistent PPI for ≥12 mo after radical prostatectomy (≥2 pads/d, no prior incontinence surgery) from 34 certified prostate cancer centers were surveyed during January-June 2025, using validated questionnaires and 24-h pad test. The primary outcome was knowledge of incontinence surgery; secondary outcomes included information sources, treatment barriers, and associations with symptom burden/quality of life. Associations with knowledge were assessed using logistic regression.
A total of 526 of 692 men participated (90% response rate). Among the participants, common reasons for not considering incontinence surgery were satisfaction with incontinence products (79%), concerns about surgical risks (53%), and doubts about success of surgery (51%). Fifty-nine percent men reported no knowledge of surgical PPI treatment. Independent predictors of lacking knowledge were low urine loss (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.7), less severe King's Health Questionnaire (KHQ)-score "role limitation" (OR 2.2, 95% CI 1.1-4.3), concerns about treatment success (OR 2.2, 95% CI 1.2-4.1), and missing information from the urologist (OR 4.2, 95% CI 1.1-16.7) or partner (OR 2.0, 95% CI 1.2-3.8). Limitations of the study include self-reported data and a nonvalidated definition of "knowledge."
Among patients with PPI for ≥12 mo after radical prostatectomy, more than half did not have any knowledge of potentially effective surgery. Information deficits and symptom severity influence knowledge. Strengthening guideline-based information and clinician-patient communication may help close this gap.
European urology open science. 2026 Jun 22*** epublish ***
Viktoria Menzel, Christoph Kowalski, Sophie Klara Schellack, Rainer Koch, Sebastian Dieng, Axel Haferkamp, Alexander Winter, Andreas Blana, Carsten Schwarzer, Andreas Gonsior, Karl H Tully, Stefan Baltes, Ingo Kausch, Andreas Manseck, Serdar Deger, Firas Jamour, Jörg Erdmann, Ina H Kunz, Holger Kujau, Martina Schleder, Anna Schulze, Jan Ramm, Markus Straub, Jasper Koenig, Dennis Wielander, Andreas Neisius, Hans-Peter Gerbershagen, Felix Wezel, Stefan Conrad, Reinhard Hofmann, Simon Müller, Karl-Dietrich Sievert, Rishav Pradhan, Roger Riexinger, Petra Stamm, Thomas Knoll, Oliver Hahn, Johannes Graff, Ernst-Günther Carl, Johannes Huber, Christian Thomas, Martin Baunacke
Department of Urology, Medical Faculty Carl Gustav Carus TU Dresden, Dresden, Germany., Deutsche Krebsgesellschaft e.V., Berlin, Germany., OnkoZert GmbH, Neu-Ulm, Germany., Department of Urology, University Hospital Johannes Gutenberg, Mainz, Germany., University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany., Department of Urology, Klinikum Fürth, Fürth, Germany., Department of Urology, Klinikum Dortmund, Dortmund, Germany., Department of Urology, University Hospital Leipzig AöR, Leipzig, Germany., Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., KRH Klinikum Region Hannover, Klinikum Siloah, Hannover, Germany., Department of Urology and Paediatric Urology, Ammerland Klinik GmbH, Westerstede, Germany., Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany., Department of Urology, Medius-Klinik Ostfildern-Ruit, Ostfildern, Germany., Department of Urology, Klinikum Westmünsterland, Ahaus, Germany., Prostate Cancer Centre Tauber-Franken, Bad Mergentheim, Germany., Department of Urology, Zeisigwaldkliniken Bethanien, Chemnitz, Germany., Department of Urology, SRH Wald-Klinikum Gera, Gera, Germany., Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany., Department of Urology, Dresden Friedrichstadt General Hospital, Dresden, Germany., Department of Urology, Sana Klinikum Leipziger Land, Borna, Germany., Department of Urology, Klinikum Landshut, Region Landshut, Germany., Department of Urology, KRH Klinikum Großburgwedel, Burgwedel, Germany., Department of Urology, Vivantes Auguste-Viktoria Klinikum, Berlin, Germany., Department of Urology, Brüderkrankenhaus Trier, Trier, Germany., Department of Urology, Klinikum Ludwigsburg, Ludwigsburg, Germany., Department of Urology, Ulm University Hospital, Ulm, Germany., Department of Urology, DIAKOVERE Friederikenstift, Hannover, Germany., Department of Urology, Klinikum Wolfsburg, Wolfsburg, Germany., Department of Urology, Klinikum Trauenstein/Kliniken Südostbayern AG, Trauenstein, Germany., Department of Urology, Medical School and University Medical Center OWL, Campus Klinikum Lippe, Bielefeld University, Detmold, Germany., Department of Urology, Katholische St. Lukas Gesellschaft mbH, St.-Josefs Hospital Dortmund, Dortmund, Germany., Department of Urology, Klinikverbund Südwest, Kreisklinikum Nagold, Nagold, Germany., Department of Urology, Heilig Geist-Krankenhaus Köln, Köln, Germany., Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany., Department of Urology, University Hospital Würzburg, Würzburg, Germany., Department of Urology, St. Elisabeth-Krankenhaus Köln-Hohenlind, Köln, Germany., Bundesverband Prostatakrebs Selbsthilfe e.V., Bonn, Germany., Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.