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Physiotherapists are increasingly utilizing pre-rehabilitation pelvic floor muscle training programs as a means of improving urinary system rehabilitation outcomes for patients recovering from radical prostatectomy. ^{(1) (2) (3) (4) (5) (8)}

There are three phases to these Physiotherapy programs:

• Pre-rehabilitation
• Benchmark
• Rehabilitation

The pre-rehabilitation period prior to the prostatectomy is important as it provides the opportunity to develop pelvic floor muscle activation and control, via a “one on one” program. It is also used to teach the patient the correct training techniques to be used in the post-operative rehabilitation phase. Generally trans-abdominal real time ultrasound RTUS is used in the teaching process and more recently is the use of real-time trans-perineal ultrasound, firstly at the initial pre Prostatectomy consultation, with additional sessions as required prior to the surgery. These sessions provide the patient with a real-time image of what the muscles are doing, and can track the progress of pelvic floor muscle control over the course of the pre-rehabilitation period. The images provided by the ultrasound are a powerful visual mental link to the ‘feeling’ of the pelvic floor muscle contractions, so to enable repetition of the feeling and hence optimize contractions during the rehabilitation phase.

The benchmark measurements of the urinary system performance are taken at the end of the pre-rehabilitation period, and comprise the keeping of a detailed written record of urinary voids generally over a 7-day period.

The rehabilitation phase only commences approximately 8-10 days after the prostatectomy. Until the catheter is removed, no pelvic floor muscle contractions or exercise are done.

When the catheter is removed the basic pelvic floor home exercise program is commenced, together with measurement and recording of urinary: voids date, time, uncontrolled volume (pads), controlled volume (no pads) etc.

The first post-surgery “one on one” physiotherapy session date is determined by consultation between the patient’s Urologist and Physiotherapist but generally is in the range of 7-14 days after the removal of the catheter. At this session, urinary measurements are reviewed and followed by a pelvic floor muscle training session. Based on this session and previous measurements, a set of home exercises is provided to the patient.

After this initial post-operative review, subsequent Physiotherapy session frequency and duration are determined on a case by case basis, and are often symptom dependent. For some patients, these reviews may be weekly or fortnightly, and will usually continue until continence is well controlled. Urinary measurements are reviewed at each session and pelvic floor muscle training exercises are individually progressed as required to assist with urinary system rehabilitation.

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