Prehabilitation Program Before Robotic Radical Prostatectomy Improves Perioperative Outcomes and Continence Recovery.

OBJECTIVES To assess the impact of a routine, on-site, one-day Prehabilitation (PreHab) program (13- 14) on perioperative and continence recovery after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS All consecutive 303 RARP 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 one-day program before the planned date of surgery (2 sessions per month including 4 patients per session). PreHab program was applied in 165 patients (54.5%). Primary endpoint was the continence recovery, strictly defined as "no safety pad" at 1 and 6 months. Secondary endpoints were perioperative parameters (blood loss, operative time, length of stay, transfusion, complication and readmission rates). Comparisons were made according to the PreHab pathway (PreHab- versus PreHab+) in univariable and multivariable models. RESULTS The PreHab pathway was applied in 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 reduced in PreHab+ group (1.3 vs 1.9 days, p=0.001). There was a trend towards fewer complications in PreHab+ group (p=0.061). PreHab pathway was independently correlated with higher continence rates at 1 (37% vs 60%, p<0.001) and 6 months (67.4% versus 87.3%, p<0.001), even after controlling for age, BMI, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation was the absence of randomization. CONCLUSIONS Our experience demonstrates that PreHab is the major predictor for improved perioperative outcomes and continence recovery after RARP with sustainable benefits 6 months after surgery.