Urinary incontinence can occur after both conservative surgical treatment for benign prostatic obstruction (BPO) and radical prostatectomy (RP) for prostate cancer (1, 2). Pelvic floor rehabilitation with pelvic floor muscle training (PFMT), electrostimulation (ES), biofeedback (BFB), and bladder training (BT) is now considered to be the first-line treatment for post-surgical urinary incontinence (1, 2). Interventions are mainly based on evidence from RP studies (3). We aim at evaluating rehabilitation outcomes in post-surgical (radical and conservative) urinary incontinence and the influence of the type of surgery.

We retrospectively examined a cohort of patients between January 2020 and October 2024, excluding patients with neurogenic bladder and incomplete rehabilitative treatment. The rehabilitation program included 10 physiotherapy sessions (3 times/week) of PFMT, BFB, ES, and BT. Functional outcomes included the use of protective pads before and after treatment, 1-hour and 24-hour pad testing, day- and night-time urinary frequency, functional tests (PFM strength test, endurance, clinical stress leakage), the need for surgery for incontinence, and the start of specific pharmacological therapy for urinary incontinence. Patients were divided into two groups: Group A (surgery for BPO) and Group B (RP); after the supervised rehabilitation program, patients continued to strengthen the PFM at home 3 times/week until the clinical control.

76 patients were included (Group A=32, Group B=44). The median time between surgery and the first physiatric consultation was 4 months (SD=58 months). Patients underwent an average of 10 sessions (SD=4 sessions) in both groups (p=0.789). The descriptive characteristics of the two groups were comparable, except for age (74 years in Group A, 69 years in Group B, p=0.004) and ongoing pharmacological therapy for incontinence at the time of the first evaluation, taken by a greater number of patients in Group A (p=0.008). Regarding functional outcomes, in both groups we demonstrated significant increase in PFM strength test and endurance, a reduction of leakages at cough test and at the 24-hour pad test as well as a decrease in the number of pads used. Only in Group B there was a significant reduction in the 1-hour pad test (p=0.044) and in night-time urinary frequency (p=0.016). Only in Group A there was a reduction in the number of patients using pads after the rehabilitative treatment (p=0.025). Finally, no differences between groups were found in post-treatment outcomes.

Both groups showed improvements in urinary continence, both in terms of urinary leakage during the day and in the number of pads used, regardless of the type of surgery and the age differences between groups. The significant reduction in night-time urinary frequency in RP Group could be related to a lower urgency component in this group and in a gradual spontaneous improvement in sphincter function: we can hypothesize that these patients recover sphincter function more significantly, especially its phasic component, and the ability to resist sudden increases in abdominal pressure, with improvement in the 1-hour pad test. We also observed a trend in nocturnal urination frequency reduction and 1-hour pad test improvement, as well as in post-treatment absorbent pads discontinuation, in both groups and at the whole cohort level. We cannot exclude that sample size may have affected our statistical power at single-group level. Finally, our study suggests that the wide variability in rehabilitative treatment initiation, with patients starting it even years after surgery, does not affect clinical improvement of incontinence.

Our study shows significant functional improvements after rehabilitation treatment in both BPO and RP groups, suggesting that interventions after radical surgery can be effective for urinary incontinence after benign surgery as well.

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Geraghty K, Keane K, Davis N. Systematic review on urinary continence rates after robot-assisted laparoscopic radical prostatectomy. Ir J Med Sci. 2024;193(3):1603-1612. doi:10.1007/s11845-023-03603-3
Canning A, Raison N, Aydin A, Cheikh S, Shamim Y. A systematic review of treatment options for post - prostatectomy incontinence. World J Urol. 2022;40(11):2617-2626. doi:10.1007/s00345-022-04146-5