Radical prostatectomy is associated with pelvic floor dysfunctions, including urinary incontinence and decreased functional capacity. While pelvic floor muscle (PFM) training is known to aid recovery, there is limited evidence regarding the feasibility and outcomes of community-based rehabilitation programs. This study aimed to evaluate the feasibility, patient adherence, and functional outcomes of a community-delivered pelvic floor rehabilitation program after radical prostatectomy.

This descriptive observational study included prostate cancer patients who had undergone radical prostatectomy and participated in a community-based pelvic floor rehabilitation program. Patients were referred to the physiotherapy unit of a Healthy Life Center operated under the District Health Directorate, either through primary care physician referrals or through community screening programs. Patients were evaluated at three time points (baseline, mid-intervention, post-intervention). Data collected included demographic characteristics, physical activity levels (MET-min/week), and functional outcomes: PFM strength (manual muscle testing), PFM endurance (seconds), functional mobility (Timed Up and Go Test, TUG), and quality of life (Functional Assessment of Cancer Therapy-Prostate, FACT-P). Home exercise adherence and patient satisfaction (Visual Analog Scale) were also recorded.

The time from surgery to initial rehabilitation was recorded, along with the intervals between follow-up sessions. Descriptive statistics (mean, standard deviation, minimum, maximum) were used to summarize the data. No control group was included.
Ethical Consideration: Ethical approval will be obtained prior to the publication and formal use of patient data.

A total of 138 patients with a mean age of 67.6±5.3 years and a mean BMI of 26.5±4.0 kg/m² participated in the study. The average time from radical prostatectomy to the initiation of rehabilitation was 58 days. Throughout the intervention period, improvements were observed in all functional parameters. Pelvic floor muscle (PFM) strength increased from a baseline mean of 2.04±0.82 to 2.79±1.04 at the final evaluation. Similarly, PFM endurance improved from a mean of 11.95±2.98 seconds to 17.01±3.60 seconds. Quality of life, as measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) score, rose from an initial mean of 98.4±14.4 to 108.4±16.0 after the intervention. Functional mobility, evaluated by the Timed Up and Go (TUG) test, showed a reduction in time from a baseline mean of 12.37±1.84 seconds to 11.09±2.18 seconds post-intervention. The mean home exercise adherence rate among participants was 75.5±14.4%, and the mean patient satisfaction score measured via Visual Analog Scale was 8.1±1.2 out of 10.

The findings demonstrate the feasibility of implementing a community-based pelvic floor rehabilitation program after radical prostatectomy. Improvements were observed in pelvic floor strength, endurance, functional mobility, and quality of life measures, despite the relatively short intervention period and delayed initiation after surgery. High patient adherence and satisfaction rates support the acceptability and sustainability of the model in community health settings.

Community-based pelvic floor rehabilitation appears feasible and beneficial for functional recovery following radical prostatectomy. Future controlled studies with standardized protocols and longer follow-up are warranted to confirm these findings and to further optimize patient outcomes.

Baumann FT, Reimer N, Gockeln T, Reike A, Hallek M, Ricci C, Zopf EM, Schmid D, Taaffe D, Newton RU, Galvao DA, Leitzmann M. Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following radical prostatectomy - a systematic review and meta-analysis. Disabil Rehabil. 2022 Sep;44(19):5374-5385. doi: 10.1080/09638288.2021.1937717. Epub 2021 Sep 22. PMID: 34550846.
Milios JE, Ackland TR, Green DJ. Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urol. 2019 Nov 15;19(1):116. doi: 10.1186/s12894-019-0546-5. PMID: 31729959; PMCID: PMC6858748.
Hodges PW, Stafford RE, Hall L, Neumann P, Morrison S, Frawley H, Doorbar-Baptist S, Nahon I, Crow J, Thompson J, Cameron AP. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Urol Oncol. 2020 May;38(5):354-371. doi: 10.1016/j.urolonc.2019.12.007. Epub 2019 Dec 25. PMID: 31882228.