- Design
- Systematic review and meta-analysis of 16 randomised trials
- Population
- 1,542 men undergoing radical prostatectomy
- Primary outcome
- Urinary incontinence, erectile function and quality of life
- Effect
- Incontinence at 1 month OR 0.58 (0.39 to 0.84); at 6 months OR 0.52 (0.28 to 0.96)
A meta-analysis pooled 16 randomised trials of preoperative rehabilitation — mainly pelvic floor muscle training, sometimes with exercise — in 1,542 men undergoing radical prostatectomy. Risk of bias was generally moderate.
Prehabilitation reduced urinary incontinence at 1 month (OR 0.58, 0.39 to 0.84) and 6 months (OR 0.52, 0.28 to 0.96), with a borderline effect at 3 months and none at 12 months. Quality of life improved at 3 months (SMD −0.70) and 6 months (SMD −0.45). Incontinence severity and erectile function did not change.
The benefit is earlier recovery of continence rather than a better final outcome. Early continence matters to men returning to work and daily life, and the intervention is low-cost and low-risk.
- Offer structured pelvic floor training from the time of listing for prostatectomy.
- Tell men prehabilitation speeds continence recovery, not the final result at a year.
- Do not promise better erectile function from prehabilitation.
- Combine with general exercise where fitness is poor.
Why it matters
It moves continence training from a postoperative afterthought to part of preoperative preparation.
Don't overread it
The benefit fades by 12 months, and there was no effect on erectile function.
The statistics, in plain English
An OR of 0.58 at one month means about 40% lower odds of being incontinent. The 6-month interval (0.28 to 0.96) is close to 1, so that estimate is less certain. Different programmes were pooled, so the best regimen is not known.
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