Physiotherapy for Urinary Incontinence After Radical Prostatectomy: Current Evidence and Therapeutic Challenges

Urinary incontinence remains one of the most frequent and distressing complications after radical prostatectomy and can substantially affect quality of life. Physiotherapy, particularly pelvic floor muscle training (PFMT), is widely used as part of conservative postoperative management; however, substantial variation exists in patient populations, surgical and perioperative factors, intervention protocols, timing of initiation, adjunctive modalities, outcome definitions, and follow-up. This narrative review summarizes current evidence on pelvic floor rehabilitation after radical prostatectomy, focusing on prehabilitation, PFMT, biofeedback, electrical stimulation, neuromodulation, and emerging modalities such as transfer energy capacitive and resistive (TECAR) therapy. PFMT is the most widely studied conservative physiotherapy intervention and may accelerate early recovery of continence in some patients, although its effects on longer-term continence rates are less certain. The role of biofeedback and electrical stimulation remains unclear because of heterogeneous protocols and inconsistent outcome reporting. Evidence for neuromodulation is limited and should be interpreted according to the specific intervention and study population. TECAR therapy currently lacks direct clinical evidence supporting its efficacy in post-prostatectomy urinary incontinence. Across the literature, differences in continence definitions, intervention content and dose, baseline symptom severity, surgical techniques, timing of treatment, and follow-up complicate direct comparison and may confound observed improvements because spontaneous recovery is common after surgery. Current evidence supports PFMT as a reasonable core component of conservative management after radical prostatectomy, particularly for accelerating early continence recovery, whereas long-term superiority and the added value of adjunctive modalities remain uncertain.