Single-session pelvic prehabilitation improves continence recovery after robot-assisted radical prostatectomy: a...

Post-robot-assisted radical prostatectomy (RARP) urinary incontinence (PPI) represents the functional complication with the greatest negative impact on the patient's global quality of life (QoL). Although the role of Pelvic Floor Muscle Training (PFMT) is widely established in perioperative clinical management, it is mostly delivered on demand after surgery. This study primarily assesses the clinical efficacy of pelvic prehabilitation when systematically implemented compared with usual care. This is a prospective, non-randomized, quasi-experimental (before-and-after) study comparing all consecutive patients undergoing RARP prior to the implementation of the PFMT program with an equally sized cohort of consecutive patients exposed to PFMT before RARP. PFMT consisted of a standardized 60-minute group session delivered by dedicated pelvic physiotherapists, including pelvic floor anatomy education, supervised proprioceptive and contraction exercises, and prescription of a structured home-based training program. The primary endpoint was post-operative continence, defined as no need for pads after surgery. Functional outcomes were also assessed using the UCLA-PCI and SF-36 questionnaires at 1, 3, and 6 months after surgery, and the recourse to post-operative PFMT. Additionally, a composite variable named "True Clinical Need" was defined as no incontinence at 6 months plus a moderate/severe subjective bother (score 3 or 4 on question Q5 of the UCLA-PCI). Finally, a cost-avoidance analysis on preoperative PFMT was performed. Overall, 214 consecutive subjects were recruited: 107 per our standard pathway (no-PFMT group) and 107 who received PFMT before RARP (PFMT group). Patient-reported satisfaction and adherence to the home-based program were high (both > 8/10 on a Likert scale). Demographic, oncological, and surgical features were comparable between the two groups. The PFMT group demonstrated significantly better 6-month continence rates (82.0% vs. 66.7%, p = 0.025) and urinary function scores (57.9 vs. 51.7, p = 0.045) compared with the NO-PFMT group. The recourse to individual postoperative cycles was similar between groups (no-PFMT 3.7% vs. PFMT 5.6%), as well the true clinical need (no-PFMT 16.1% vs. PFMT 11.2%). A cost-avoidance analysis showed that prehabilitation would yield an estimated net saving of €165 per patient. A single PFMT session could significantly improve continence recovery at 6 months after RARP within economic sustainability.