Functional recovery after robot-assisted radical prostatectomy (RARP), particularly urinary continence and erectile function, remains a major postoperative challenge. Standard pelvic floor muscle training (PFMT) is routinely recommended, but its effectiveness may be limited by poor proprioceptive awareness and difficulty achieving correct pelvic floor activation. This study aimed to evaluate whether Pelvic Clock®-assisted rehabilitation, in addition to standard PFMT, was associated with improved early functional recovery after RARP.

This retrospective cohort study included men undergoing RARP for localized prostate cancer at a single tertiary center between 2024 and 2025, with at least 6 months of follow-up. Patients were classified according to documented postoperative rehabilitation as Pelvic Clock®-assisted rehabilitation plus standard PFMT or standard PFMT alone. Functional outcomes were assessed preoperatively and at 1, 3, and 6 months after surgery. The primary outcome was a study-specific 6-month composite endpoint defined as PSA <0.2 ng/mL, social continence (≤1 pad/day), and International Index of Erectile Function-5 (IIEF-5) ≥17. Secondary outcomes included daily pad use, social continence rate, EPIC urinary score, Oxford pelvic floor muscle strength score, and pain visual analogue scale (VAS). Longitudinal outcomes were explored using mixed-effects models adjusted for age, BMI, preoperative PSA, prostate volume, and nerve-sparing status.

A total of 55 patients were analyzed, including 25 in the Pelvic Clock group and 30 in the standard PFMT group. Baseline demographic and perioperative characteristics were broadly comparable between groups, although bilateral nerve-sparing was less frequent in the Pelvic Clock group. The 6-month composite endpoint was achieved more often in the Pelvic Clock group than in the standard PFMT group (60.0% vs 16.7%; unadjusted OR 7.50, 95% CI 2.15–26.17). In a post hoc model adjusting for nerve-sparing status only, the association remained similar (adjusted OR 7.82, 95% CI 2.14–28.58). Early urinary recovery favored the Pelvic Clock group, with lower pad use at 1 month (2.00±0.96 vs 3.30±1.78 pads/day; adjusted difference -1.30, 95% CI -1.89 to -0.71; p<0.001) and higher social continence rates at 1 month (36.0% vs 6.7%) and 3 months (92.0% vs 60.0%). EPIC urinary scores were consistently higher in the Pelvic Clock group at 1, 3, and 6 months (all p<0.001). The Pelvic Clock group also showed higher IIEF-5 scores at 3 and 6 months and lower pain scores at 3 and 6 months.

Pelvic Clock®-assisted rehabilitation was associated with faster early postoperative recovery after RARP, particularly in urinary outcomes during the first 3 months, with additional benefits in urinary quality of life and pain reduction. However, because all patients met the PSA component and most patients were socially continent by 6 months, the between-group difference in the composite endpoint was driven mainly by erectile function recovery. These findings should therefore be interpreted cautiously in view of the retrospective design, small sample size, and incomplete documentation in some intervention cases

Adding Pelvic Clock®-assisted rehabilitation to standard PFMT may improve early functional recovery after RARP, especially early continence recovery and patient-reported urinary outcomes. Prospective randomized studies are needed to confirm these findings and clarify the role of proprioceptive pelvic rehabilitation after prostatectomy.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024;74(3):229-63.
Xu M-Y, Zeng N, Ma S, Hua Z-J, Zhang S-H, Xiang J-C, et al. A clinical evaluation of robotic-assisted radical prostatectomy (RARP) in located prostate cancer: A systematic review and network meta-analysis. Critical Reviews in Oncology/Hematology. 2024;204:104514.
Inoue S, Hayashi T, Teishima J, Matsubara A. Comparative Analysis of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Regarding Lower Urinary Tract Symptoms: A Longitudinal Study. Urological Science. 2020;31(1).