In Germany, this is the first interdisciplinary, consensus-based guideline focusing on urotherapeutic care before and after radical prostatectomy for non-invasive prostate cancer with a primary emphasis on health-related quality of life (HRQoL) and patient and caregiver experiences. The aim was to develop structured, evidence-informed recommendations for conservative, non-surgical urotherapeutic interventions across the perioperative care pathway in order to reduce functional impairments, support coping strategies and improve participation and the wellbeing of affected men and their caregivers.

A clinical, non-surgical S2 guideline was developed by a multidisciplinary working group following established guideline development standards. Systematic literature searches were conducted in PubMed, Cochrane Library, Google Scholar and Livivo to identify evidence related to urotherapy, post-prostatectomy incontinence, erectile dysfunction, patient education, rehabilitation and quality of life outcomes. Eligible publications included clinical studies, systematic reviews and relevant guideline literature. Based on the identified evidence, recommendations were formulated through a structured consensus process and classified as strong recommendations, recommendations or open recommendations. The guideline addresses urotherapeutic interventions throughout all phases of care, including preoperative education, acute postoperative management, rehabilitation and long-term follow-up, with particular attention to patient education, self-management support and the involvement of caregivers.

The guideline highlights that urinary incontinence and erectile dysfunction following radical prostatectomy are strongly associated with reduced HRQoL, psychological distress, social withdrawal and impaired participation. Key recommendations emphasise early initiation of urotherapeutic support prior to surgery, structured patient education, continence training, counselling on coping strategies and needs-based guidance on continence products and self-care. Continuous urotherapeutic support across care settings was identified as essential for strengthening self-efficacy, promoting active coping and reducing uncertainty in patients and caregivers. Caregiver burden related to incontinence management, intimate care and psychosocial stress was also identified as an important but often under-recognised aspect influencing overall quality of life.

The findings demonstrate that urotherapy is not limited to functional rehabilitation but represents a central component of patient-centred prostate cancer care. Addressing physical symptoms alone is insufficient; structured education, counselling and long-term support are required to mitigate the psychosocial consequences of post-prostatectomy incontinence and sexual dysfunction. By integrating urotherapy into the perioperative pathway, unmet informational and supportive needs of patients and caregivers can be addressed more effectively, potentially improving adherence, participation and quality of life outcomes.

This approach provides the first structured framework integrating urotherapy into perioperative care for non-invasive prostate cancer with a clear focus on quality of life and patient and caregiver experiences. Systematic, needs-based urotherapeutic support before and after radical prostatectomy should be considered an essential component of clinical, non-surgical prostate cancer management.

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