A prehabilitation programme implemented before robot‐assisted radical prostatectomy improves peri‐operative outcomes and continence recovery

Abstract

To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). Materials and MethodsAll 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHabÀ) in univariable and multivariable models. ResultsThe PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. ConclusionsOur experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.

Non‐pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review

“…A cohort study (Rahota et al, 2022) initiated a 1‐day prehabilitation program when men wait at home for surgery and it demonstrated beyond expected in continence recovery and other perioperative outcomes. In the study by Goode et al (2022), intervention group received a perioperative behavioural program, control group received general education, both delivered by mHealth which using mobile to send several 5–10 min sessions' hyperlink for 1–4 weeks prior to and 8 weeks after surgery.…”

Patient experience and satisfaction after same-day discharge radical prostatectomy using a personalized, digital perioperative programme

“…A large amount of data suggests that better patient preparation and care coordination at home could meaningfully improve outcomes and patient experience after surgery and facilitate early discharge [ 9 ]. We previously demonstrated that the implementation of a dedicated prehabilitation programme increased the acceptance of SDD RARP in routine practice without compromising postoperative outcomes [ 10 ].…”