Pelvic Floor Rehabilitation After Prostatectomy: Baseline Severity as a Predictor of Improvement-A Prospective Cohort Study

Abstract

Background/Objectives: Urinary incontinence (UI) is a frequent and distressing complication after radical prostatectomy (RP). Pelvic floor muscle training (PFMT) is widely recommended as first-line rehabilitation, yet the clinical factors influencing its effectiveness remain incompletely understood. Methods: This prospective cohort study included 182 men undergoing RP who completed a standardized physiotherapy program involving pelvic floor muscle exercises, biofeedback (BFB), and ultrasound-guided training. UI severity was assessed using the 1-h pad test and recorded absorbent product use. Outcomes were evaluated at three time points: one month, three months, and six months post-catheter removal. A multiple linear regression model was used to identify the predictors of continence improvement, defined as the change in pad test result between baseline and six months. Results: Pad test results and absorbent use decreased significantly across all UI severity stages (p < 0.0001). The greatest absolute improvement was observed in patients with severe incontinence at baseline (UI stage 3: mean reduction from 130.8 g to 23.7 g). Regression analysis revealed that only the baseline pad test result was significantly associated with the magnitude of improvement (β = 0.91; 95% CI: 0.85-0.97, p < 0.001; R² = 0.89). Age, BMI, and time to rehabilitation were not significant predictors. Conclusions: Pelvic floor rehabilitation after RP is effective in improving continence, including in patients with severe baseline symptoms. The baseline pad test value emerged as the strongest predictor of rehabilitation response, highlighting the importance of initial assessment. These findings support the use of PFMT in clinical practice and emphasize the need for individualized treatment planning based on baseline UI severity.

Keywords: incontinence; pelvic floor physical therapy; prostate cancer; prostatectomy.

Figure 1

Distribution and changes in pad test results (g) across three postoperative examinations. Note: The left panel presents baseline pad test values by urinary incontinence (UI) stage. The middle panel shows overall mean improvement over time. The right panel illustrates mean changes stratified by UI stage. All comparisons were statistically significant (p < 0.0001, Bonferroni corrected). Statistical comparisons were performed using the Friedman test for repeated measures.

Figure 2

Mean number of pads, diapers, and total absorbents used per day across three postoperative examinations, shown separately by urinary incontinence (UI) stage at baseline (stages 0–3). Note: Solid lines represent pads, dashed lines represent diapers, and dash-dot lines indicate total absorbents (pads + diapers). A consistent reduction in absorbent use over time was observed in all UI stage groups. Statistical significance of within-group changes was confirmed using the Friedman test (p < 0.0001 for all comparisons, Bonferroni corrected).

Figure 3

Relationship between baseline incontinence severity and improvement in pad test result. Note: Scatterplot shows the association between baseline pad test result (g) and the change (Δ) in pad test result between Examination 1 and Examination 3. The regression line and 95% confidence interval are shown. Each dot represents an individual patient. Regression line with 95% confidence interval shaded. Greater initial incontinence was associated with greater improvement (p< 0.001, R² = 0.89).