It's been two years — will it improve?

Can continence still improve after 12 months?

Yes. A large European cohort specifically studied men who were still using at least one pad per day at 12 months. Among 974 men, 38.6% met the study’s continence definition by 24 months and 49.7% by 36 months.¹ This is an important counterweight to the common claim that “only 1%” improve after a year.

Does that mean I should simply keep waiting?

Not necessarily. Late recovery is possible, but persistent bothersome leakage is also treatable. Waiting and assessment are not mutually exclusive. You can be evaluated for the type and severity of leakage while still allowing biological recovery to continue.

What should a specialist assessment establish?

How many pads are used and how wet they are; whether leakage occurs with activity or urgency; bladder emptying; previous radiotherapy; urethral stricture history; cystoscopy where appropriate; and sometimes urodynamics. These details influence whether conservative therapy, bladder medication, a male sling or an artificial urinary sphincter is most appropriate.

When is surgery considered?

For persistent stress urinary incontinence that remains sufficiently bothersome despite conservative management. Timing is individual. Severe leakage that is clearly not improving may justify earlier discussion than mild leakage that is steadily improving.

Why was I told something different?

Different studies use different definitions. A man can move from three pads to one pad and have a major quality-of-life improvement while still being counted as “incontinent”. Conversely, a 0–1 pad definition can count daily pad use as success. Both effects complicate recovery statistics.

What does UK guidance say about timing?

The 2025 British Association of Urological Surgeons consensus answers this more usefully than anything else published.² Surgery should be offered after a minimum of six months where the leakage is severe and twelve months where it is mild to moderate, to any man sufficiently bothered by it.

That sits alongside, not against, the evidence for late recovery. Both are true, and the combination is the point: you do not have to stop recovering before you are entitled to an operation. Against a median wait in England of 2.8 years from prostatectomy to continence surgery, it is the second half of that sentence men are rarely told.

Bottom line

Two years of leakage does not mean there is no hope—but it is long enough that you deserve more than “keep doing pelvic-floor exercises and wait”. Late recovery can happen, while effective surgical options also exist. The next step is to define the problem and discuss the trade-off between further observation and active treatment.

You can be assessed while recovery continues; the two are not in competition. And you do not have to stop recovering before you are entitled to an operation — the British thresholds for offering surgery are six months for severe leakage and twelve for mild to moderate. If you are years past that and still in pads, something has gone wrong with the pathway rather than with you.