Common Questions · After prostate treatment · No. 38
Why men wait years without being referred
Sixty-two per cent of men still in two pads a day, a median eleven years after surgery, did not know an operation existed. Their urologists were their main information source.
By Mr Musaab Yassin, Consultant Urological Surgeon & Andrologist. Oxford and central London.
Persistent post-prostatectomy incontinence is not only a treatment problem; it is an information and referral problem. A 2026 study of 99 men using at least two pads per day—at a median 11 years after prostatectomy—found that 62% had no knowledge of surgical treatment options.1
How can this happen if men keep seeing urologists?
In the same study, urologists were the main information source for 88% of men.1 This suggests the gap is not simply lack of contact with healthcare. Continence may be overshadowed by cancer follow-up, men may under-report bother, or clinicians may assume that a man coping with pads does not want intervention.
Why do patients themselves not ask?
Among men in that cohort, 69% said they were coping adequately with pads, 55% doubted surgery would work and 44% feared health risks.1 “Coping” can therefore coexist with substantial leakage. Men may adapt their life so extensively that the adaptation becomes invisible to the clinic.
What should trigger referral?
Bothersome persistent stress leakage, especially if it limits exercise, travel, work, intimacy or confidence. Severity matters, but the patient’s goals matter too. A pad count is not a quality-of-life score.
What should happen before surgery?
The type of incontinence should be confirmed. This may involve history, pad use/weight, urinalysis, residual urine, cystoscopy and selected urodynamics. The purpose is to avoid treating urgency or obstruction as if it were pure sphincter weakness.
What can a patient ask directly?
“Is my leakage mainly stress incontinence?” “Am I a candidate for a sling or artificial sphincter?” “Do I need a specialist male continence referral?” These questions can expose whether the pathway has stalled.
How large is the gap in the UK?
Large, and measured.
A national linkage of NHS patient-reported outcomes to hospital records found 9.3% of men reported a “bad” incontinence score after radical prostatectomy, yet the three-year cumulative incidence of incontinence surgery was 2.5% — and among the men reporting the worst possible score, only 15.5% had surgery. A separate national study of every artificial sphincter and sling implanted in England over eight years found a median of 2.8 years between prostatectomy and continence surgery, and its authors concluded plainly that patients should be referred sooner.
This is not a knowledge gap on your side. It is a pathway that stalls unless somebody restarts it.
Bottom line
Men can remain severely incontinent for years while believing pads are the only option. The evidence shows a genuine knowledge gap. If leakage remains bothersome after prostate treatment, asking explicitly about specialist continence assessment is reasonable.
This is the statistic that changed how I run a follow-up appointment. Men cope, and coping is mistaken for contentment; nobody asks, so nobody tells. If you are still in pads and nobody has raised surgery with you, ask the question directly — am I a candidate for a sling or an artificial sphincter? It is a fair question and it deserves a straight answer.
If this sounds like you
A first consultation is £295, and follow-up £190. It usually runs at least twenty minutes; allow up to an hour if you are likely to need a scan, a flow test, or blood or urine tests on the day. You do not need a referral to book privately, and you are under no obligation to proceed with anything.
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The 1 studies behind this page▾
- Barriers to post-prostatectomy stress incontinence care: knowledge gaps, patient concerns, and urologist communication — Menzel V, Groeben C, Hoffmann F, et al.. World Journal of Urology. 2026. doi:10.1007/s00345-026-06185-8
Mr Musaab Yassin is a Consultant Urological Surgeon and Andrologist practising in Oxford and central London. FRCS (Urol). GMC 6118378. Reviewed August 2026.
This page gives general information and does not replace an individual assessment. Figures quoted come from published research and describe groups of patients rather than any one person — your own history, anatomy and priorities change what they mean for you.