Effectiveness of pelvic floor rehabilitation after radical prostatectomy and continence recovery in relation to surgical technique

The potential influence of surgical technique and pelvic floor rehabilitation on continence recovery continues to be debated. This prospective cohort study included 182 men undergoing robot-assisted or laparoscopic radical prostatectomy. All patients were referred for physiotherapist-guided pelvic floor muscle training. Urinary incontinence was assessed using a standardized 1-h pad test and a three-stage UI grading system at 1, 3, and 6 months after catheter removal. Ordinal and logistic regression models were used to identify predictors of continence, including surgical technique, age, pathological features, and rehabilitation-related variables. Exploratory time-to-event analyses (Cox proportional hazards models) were also performed to assess the dynamics of continence recovery, with catheter removal as time zero and achievement of full continence (pad test ≤ 2 g) as the event. Patients undergoing RARP demonstrated higher odds of early full continence shortly after surgery (OR = 5.26; 95% CI 2.34-11.80; p < 0.001) and functional continence (OR = 4.00; 95% CI 1.96-8.14; p < 0.001). After adjustment for baseline incontinence severity, surgical technique was no longer an independent predictor of continence recovery. However, in multivariable analyses, baseline incontinence severity and timing of rehabilitation were the strongest independent predictors of continence recovery. Robotic prostatectomy is associated with a more favorable continence status at the start of rehabilitation, whereas continence recovery during physiotherapy is primarily determined by baseline incontinence severity and timely initiation of pelvic floor therapy rather than surgical approach. These results highlight the need to integrate precise surgical techniques with standardized, early, and individualized physiotherapy to optimize continence recovery and improving quality of life after radical prostatectomy.