Barriers to post-prostatectomy stress incontinence care: knowledge gaps, patient concerns, and urologist communication

PURPOSE: Stress urinary incontinence (SUI) after radical prostatectomy markedly reduces quality of life, yet care gaps remain. This study evaluated patients' knowledge of treatment options and use of continence aids. METHODS: We analysed follow-up data from the multicentre HAROW study (2013-2018) and a cross-sectional study from Dresden (2021). Included were men up to 15 years after prostatectomy using ≥ 2 pads daily. The survey examined awareness of surgical treatments, continence aids, information sources, and barriers to therapy. RESULTS: Ninety-nine patients participated (HAROW: 62; Dresden: 37). Median age at surgery was 67 years (47-85); median postoperative interval 11 years (0-15). Continuous leakage was reported by 70% (68/97), and 53% (51/96) used > 3 pads/day. Pads were the main aid (97%, 93/96); condom catheters (12%) and penile clamps (2%) were rarely used, with 86% unaware of these options. Knowledge of surgical treatments was absent in 62% (55/89). Better awareness was linked to younger age (p = 0.002) and fewer pads used (p = 0.04). Urologists were the main information source (88%), followed by treating hospital (50%) and partners (44%). Key reasons for not seeking surgery were sufficient coping with pads (69%), doubts about efficacy (55%), and fear of health risks (44%). CONCLUSION: Most men with SUI after prostatectomy remain poorly informed about surgical options despite frequent urologist consultations. Fear and misconceptions limit therapy uptake. Structured, targeted education is needed to bridge the gap between clinical need and treatment, potentially improving utilization and quality of life.