Transition to a digital perioperative pathway for robot‐assisted radical prostatectomy: impact on patient outcomes and adherence

Objectives To test whether prehabilitation (PreHab), delivered digitally or as digital + on‐site, improves early continence after robot‐assisted radical prostatectomy (RARP) vs no PreHab, and to evaluate implementation by quantifying programme uptake after transitioning from an on‐site programme to a digital pathway. Patients and Methods Two‐centre, high‐volume, non‐randomised before–after consecutive cohort over 3 years ( N = 350; Control = 204; PreHab = 146). PreHab combined pelvic floor muscle training, structured education, and optimisation via a smartphone pathway with or without a 1‐day class. Primary outcome: 6‐week continence (0–1 pad/day). Secondary outcomes: same‐day discharge (SDD), complications (Clavien–Dindo Grade ≥III), 30‐day unplanned visits and readmissions, postoperative physiotherapy, satisfaction (0–10 visual analogue scale), and continence at 6 and 12 months. Group comparisons used chi‐square/Fisher's and Mann–Whitney U ; multivariable logistic regression provided adjusted estimates. Results For the PreHab vs Control cohorts: 6‐week continence 84.2% vs 67.6% ( P = 0.003); SDD 47.3% vs 35.3% ( P = 0.025); high‐grade complications 2.1% vs 7.4% ( P < 0.001); mean (standard deviation) satisfaction score 9.4 (0.7) vs 8.4 (1.3) ( P < 0.001). Readmissions 3.4% vs 7.8% ( P = 0.086) and unplanned visits 3.4% vs 6.4% ( P = 0.218) were not different. Continence remained higher with PreHab at 6 months 97.7% vs 84.3% ( P < 0.001) and 12 months 99.2% vs 93.6% ( P = 0.004). Adjusted analyses showed lower odds of 6‐week incontinence (odds ratio 0.43, 95% confidence interval 0.22–0.85; P = 0.015). Uptake rose from 26.6% (on‐site era) to 48.2% and 68.7% across successive digital periods ( P < 0.001). Effects did not differ by delivery mode. Conclusions Prehabilitation, regardless of delivery mode, improves early continence vs no PreHab without compromising safety; digitisation increased programme uptake, indicating that digital PreHab is an effective and scalable option.