A Randomized Trial of Multimodal Prehabilitation Before Robotic-Assisted Radical Prostatectomy to Improve Postoperative Quality of Life and Functional Outcomes
In brief
Four-week prehabilitation lifts quality-of-life scores 15 points after prostate surgery
In a single-center randomized trial of 95 men, a four-week program of exercise, pelvic floor training, nutrition counseling and psychological support improved quality-of-life scores by 15 points on a 100-point scale one month after robotic prostate surgery. Urinary continence and some mental health and quality-of-life gains persisted, but the overall benefit narrowed by six months, with no improvement in physical performance or erectile function.
- Journal
- The Journal of urology (Q1)
- Published
- 28 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Enric Carbonell, Fernando Dana, Beatriz Tena, Raquel Sebio-García, Raquel Salinas-González, Bárbara Romano-Andrioni, et al.
- PMID
- 42949849
- DOI
- 10.1097/JU.0000000000005365
Why clinicians should know about it
- Picked for Urology (top studies of the week, 8 November 2026): Prehabilitation RCT improves post‑RARP recovery
Abstract
PURPOSE: Robotic-assisted radical prostatectomy (RARP) causes postoperative impairments. Although prehabilitation has shown benefits in surgical populations, data specific to RARP remain limited. We evaluated whether multimodal prehabilitation improves early postoperative health-related quality of life (HRQoL), functional recovery and mental health. MATERIALS AND METHODS: Prospective, single-center randomized trial including men with prostate cancer scheduled for RARP (May 2022- September 2024). Participants were randomized to a 4-week multimodal prehabilitation program including physical and pelvic floor muscle training, nutritional counselling and psychological support or to usual care. The primary outcome was change in the EORTC QLQ-C30 global health status score from baseline to 1 month after surgery. Secondary endpoints included functional and perioperative outcomes at 1, 3 and 6 months. RESULTS: Ninety-five of 100 randomized patients were analyzed (53 prehabilitation, 42 control). At 1-month post-operatively, global health status score was higher in the prehabilitation group (adjusted mean difference +15 points, 0-100 scale; 95% confidence interval (CI) 7-22; p<0.001). Improvements at 1-month were also observed in several HRQoL domains, mental health and urinary continence (mean difference in ICIQ-UI SF -2.7; p=0.032). No differences were detected in physical performance or erectile function. Prehabilitation benefits attenuated over time, with the global health status difference decreasing to +4.5 points at 6 months (-1.9 points/month; p = 0.024), whereas improvements in selected HRQoL domains, mental health, and ICIQ-UI SF were maintained throughout follow-up. CONCLUSIONS: Multimodal prehabilitation before RARP is feasible and should be integrated into clinical practice, as it enhances postoperative recovery and patient-centered outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.