Stress urinary incontinence (SUI) is a common complication following radical prostatectomy, and its severity is critical in guiding surgical management, particularly when selecting between a male sling and an artificial urinary sphincter. Although the 24-hour pad test is widely used to assess incontinence severity, the role of the Standing Cough Test (SCT) and the Repositioning Test (RT) remains unclear. We aimed to evaluate the correlation between SCT and RT, and established objective and subjective measures of post-prostatectomy incontinence severity, as well as their impact on quality of life.

We conducted a cross-sectional study including patients with SUI following radical prostatectomy. All patients underwent a 24-hour pad test, classifying leakage as mild (≤50 g), moderate (50–200 g), or severe (>200 g). The SCT was performed in the standing position during cough maneuvers and graded from 0 to 4: grade 0 (no leakage), grade 1 (delayed drops only), grade 2 (early drops without stream), grade 3 (early stream), and grade 4 (persistent early stream). The RT was performed during cystoscopy (21Fr) under local anesthesia. External urethral sphincter contraction was assessed after manual repositioning of the bulbar urethra and classified as positive (complete contraction) or negative (absent or partial contraction). Patient-reported outcomes were evaluated using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). Categorical variables were compared using the chi-square test or Fisher’s exact test. Continuous variables were analyzed using the Mann–Whitney or the Kruskal–Wallis test with Dunn’s post hoc analysis. Correlations were assessed using Spearman’s coefficient. Statistical significance was set as p < 0.05.

A total of 51 patients were included. Among them, 64.7% undergone open retropubic radical prostatectomy, and the remainder had undergone laparoscopic surgery. All patients were at least 12 months postoperative. Median age was 66 years, and  31.4% of patients had received adjuvant or salvage radiotherapy. When patients were stratified by pad test severity (<200 g vs >200 g), those with severe incontinence (>200 g) had higher SCT grades 3 and 4 (p=0.0106), a higher prevalence of negative RT results (p=0.0327), and higher ICIQ-SF score (p=0.0287). As the pad test increases (mild to moderate to severe) no significant differences in SCT grades (p=0.1669) were observed, there was a trend towards a higher rate of negative RT results (p = 0.0741), and there was a higher ICIQ-SF scores (p=0.0487). No significant association was found between RT results and mean SCT grade (p=0.6302). Radiotherapy and surgical approach were not associated with differences in test outcomes.

To our knowledge, this is the first study to compare tests using different assessment methods. We observed a correlation between the severity of leakage measured by the pad test and the SCT, as patients with SCT grades 3 and 4 were more likely to present severe incontinence, defined by >200g in pad test weight. Our results suggests that a negative RT is more frequently associated with severe incontinence. Severe leakage measured by the pad test and a negative RT, both correlates with a worse impact on quality of life as assessed by the ICIQ-SF questionnaire. A negative RT provides functional information about the absence of urethral sphincter competence that is not fully assessed by other diagnostic methods.

The SCT correlates with the pad test, proving to be a sensitive and easy-to-perform test. The RT does not identify different degrees of severity of urinary incontinence. A negative RT indicates the absence of sphincter activity. The higher the pad weight, the greater the negative impact on quality of life. The RT can represent a useful adjunct in the preoperative evaluation and in the surgical decision-making process for the treatment of the male incontinence.

Continence 19S (2026) 102513
DOI: 10.1016/j.cont.2026.102513