Aquatic pelvic floor rehabilitation for persistent stress urinary incontinence after robot-assisted radical prostatectomy: a prospective single-arm study

BACKGROUND: Persistent stress urinary incontinence (SUI) remains one of the most troublesome functional complications after robot-assisted radical prostatectomy (RARP). Although pelvic floor muscle training (PFMT) represents the standard conservative treatment, a proportion of patients continue to experience bothersome symptoms. Aquatic rehabilitation may facilitate pelvic floor activation through reduced gravitational loading, enhanced proprioceptive input, and trunk stabilization; however, its role in post-prostatectomy incontinence has not been investigated. This prospective pilot study evaluated the feasibility, safety, and clinical outcomes associated with hydrokinesitherapy in men with persistent SUI following RARP. Methods: Men with persistent pure SUI after rArP despite three months of standardized conservative management, including PFMT and biofeedback, were prospectively enrolled between January and May 2023. Participants underwent a five-week hydrokinesitherapy program consisting of ten supervised 40-minute sessions performed twice weekly. outcomes included the 24-hour pad test, International Consultation on Incontinence Questionnaire-short Form (ICIQ-sF), Incontinence Quality of Life questionnaire (I-QoL), International Prostate symptom score (IPSS), IPSS quality-of-life item, and Patient Global Impression of Improvement (PGI-I), assessed at baseline, end of treatment (5 weeks), and 12-week follow-up. RESULTS: Twenty patients completed the rehabilitation program without treatment-related adverse events or dropouts. significant improvements were observed at the end of treatment in pad weight, IPSS, IPSS-QoL, ICIQ-SF, and I-QoL scores (all p ≤ 0.01). These improvements were maintained or further improved at 12 weeks, particularly for pad weight, QoL, and incontinence-related symptom scores. overall patient satisfaction was high according to PGI-I. Two patients (10%) subsequently underwent male sling surgery because of persistent bothersome sUI. Conclusions: Hydrokinesitherapy was feasible, safe, and associated with clinically meaningful improvements in urinary continence and health-related QoL in men with persistent SUI after RARP who had not achieved satisfactory recovery following initial conservative rehabilitation. These findings should be considered hypothesis-generating and warrant confirmation in adequately powered randomized controlled trials.