Pelvic floor rehabilitation before radical prostatectomy: a systematic review

To review the effectiveness of pelvic floor muscle strengthening before radical prostatectomy.

A search of publications was conducted in the following databases: PubMed, Scopus, Cochrane and Enfispo for articles published from 2019 to September 2024. A total of 199 articles were reviewed, of which 6 were selected and peer-reviewed using the CASPe questionnaire to assess methodological quality, resulting in the inclusion of 5 studies with a total of 642 participants.

Pelvic floor prehabilitation in patients undergoing radical prostatectomy aims to improve urinary continence, sexual function and quality of life. The studies analyzed show significant methodological variability, adding difficulty in comparing the results. Treatments that combine pelvic floor exercises with aerobic and resistance training show better functional recovery and continence outcomes. Less intensive programs do not show significant differences between groups. Studies with longer durations demonstrate clearer benefits, while shorter follow-up periods limit the evaluation of long-term efficacy. Additionally, few studies address erectile dysfunction, despite its impact on quality of life.

Pelvic floor prehabilitation may help improve urinary continence following radical prostatectomy; however, there is a paucity of studies evaluating its application prior to surgery, and considerable variability exists in treatment protocols. No standardized clinical protocol exists, which hinders result comparisons. Although prehabilitation shows promising potential, current studies present heterogeneous results. Clinical trials are needed to standardize interventions, expand sample sizes, and conduct long-term follow-ups to consolidate evidence and improve patient care.

Prospero Register: CRD42024619694.