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In the 22,160 patients treated in Germany for prostate cancer by prostatectomy, the costs for direct and indirect sequelae as the result of postoperative urinary incontinence are estimated to be 71.8 million €. This greatly exceeds the costs of 69.8 million € for the operation itself. This additional economic burden can, however, be decisively influenced by using a surgical technique that preserves the integrity of the urethral sphincter.

Being afflicted with urinary incontinence in old age represents manifold medical, social, and economic problems and restrictions. The objective loss of control and decreased self-confidence result in reduced social interactions and lead to isolation and ostracism accompanied by withdrawal and depression. Giving up leisure time activities, losing social contacts, and the increasing need for long-term care often lead inevitably to a higher degree of dependency and institutionalization. In addition, the taboo still placed on this problem by those affected as well as by the attending physicians has resulted in too few patients receiving adequate diagnosis and being offered sensible treatment options. These problems can only be solved by an interdisciplinary approach. Further information, continuing education, and sensitivity toward these aspects are needed. Only then can incontinence in old age as a social and economic problem exacerbated by the demographic changes be improved.

A renaissance of conservative treatment for urinary incontinence and descensus is taking place presently in the German speaking area for pre-surgical improvement of tissue quality as well as for long-term-treatment replacing or postponing surgery. Modern pessaries (shape and material), a more intense and pathophysiological well-founded physiotherapy as well as the support of treatment by electrostimulation and its completion by adequate hormone substitution lead to a successful conservative treatment. "Gesundheitsstrukturreform" (reformatory measures of the German Public Health System), "Fallpauschalen" (flat-rate tariff of treatment by the case) and "Praxisbudgets" (budgets for out-clinic-treatment by the case, also a form of flat-rate tariff) lead to a restriction in prescribing necessary conservative treatment or preventive measures. Assigning the patient to surgical treatment is therefore in large parts favoured (treatment costs are then charged to clinic budgets). On the basis of the presented exemplary cost analysis completed by data on subjective effectiveness, acceptance and evaluation of efforts for patient and doctor we want to show that it is not either method that has to be considered in the treatment but both. Besides we have to treat the patient sequentially-conservative treatment in most cases first, especially in younger women. Conservative treatment thereby offers the possibility to delay or postpone surgery, a very meaningful option offered regarding the relatively poor results of surgery especially in cases of recurrent disease.