The strongest predictor of whether a man regains continence after radical prostatectomy is not his age. In this trial age did not predict success at all — time since surgery did, and it predicted failure.
That points at a scheduling problem rather than a clinical one. The referral usually goes in when the patient complains, which is weeks or months after the catheter comes out, by which time the window has narrowed.
So make the referral part of the operative pathway: booked preoperatively, started as soon as the catheter is out, with the first appointment already in the diary before the patient goes home. And measure with a 24-hour pad weight rather than asking how many pads — the number of pads tells you about the patient's habits, the weight tells you about the leak.
- Book pelvic floor training as part of the preoperative pathway, not on complaint
- Age should not be used to decide who is offered training
- Measure with 24-hour pad weight, not pad count
- If physiotherapy is not available, a biofeedback device is a reasonable substitute
Why it matters
The variable that predicts continence recovery is one the service controls, not one the patient brings.
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