# Prehab before prostatectomy: meta-analysis finds earlier continence, erectile effect unclear

> A 16-trial meta-analysis reported by Bioengineer.org found preoperative training lowered odds of incontinence at one and six months after radical prostatectomy, with no significant improvement in leakage severity or erectile function.

AthleticsMD Clinical Desk · 2026-10-13 · https://blog.athleticsmd.org/prehab-before-prostatectomy-meta-analysis-finds-earlier-continence-erectile-effe

On October 13, 2026, Bioengineer.org carried a Scienmag report on a systematic review and meta-analysis in Supportive Care in Cancer that examined prehabilitation before radical prostatectomy [1]. Prehabilitation here means structured training in the weeks before an operation to build functional reserve, and radical prostatectomy is surgical removal of the prostate as a curative cancer treatment [1]. Pooled trial data showed lower odds of urinary incontinence in the early months after surgery and better short-term quality of life, but no significant improvement in leakage severity or erectile function [1].

## The study

The review was led by Wenxue Wan of the School of Nursing at China Medical University in Shenyang, with colleagues at Kunshan First People's Hospital, and pooled 16 randomized controlled trials with 1,542 participants [1]. A meta-analysis statistically combines results from separate studies; the team searched four databases, with two reviewers independently selecting studies, extracting data and assessing bias, under a protocol registered with PROSPERO (CRD420251183407) [1].

Most trials tested pelvic floor muscle training, in which patients learn to deliberately contract and relax the levator ani muscles that support the bladder and urethra [1]. Some added biofeedback, which uses sensors to give real-time cues about whether the correct muscles are engaged, and others used broader exercise, stress management, or combined physical and psychological preparation [1].

## Findings

- Incontinence at one month: odds ratio (OR) 0.58, 95% confidence interval (CI) 0.39 to 0.84; an OR below 1 indicates lower odds of the outcome with prehabilitation than with usual care [1].
- Incontinence at six months: OR 0.52, 95% CI 0.28 to 0.96 [1].
- Incontinence at three months: a borderline reduction that was not statistically significant; by twelve months, the difference between groups was no longer apparent [1].
- Incontinence severity: no significant improvement at any follow-up point [1].
- Erectile function: no significant benefit at any follow-up point [1].
- Quality of life, reported as a standardized mean difference (SMD), an effect size that allows scores from different questionnaires to be pooled: SMD −0.70 (95% CI −1.08 to −0.32) within the first three months and −0.45 (95% CI −0.74 to −0.16) at six months [1].
- Quality of life at twelve months: SMD −0.33 (95% CI −0.66 to 0.00), which did not reach statistical significance [1].

## Why it matters

The report describes the weeks between a prostate cancer diagnosis and surgery as an underused window, and these pooled trials suggest that preoperative pelvic floor training can improve the early recovery period, when leakage is most distressing [1]. The time course led the report to conclude that prehabilitation seems to "accelerate the trajectory to continence rather than raise its ultimate ceiling" [1]. For men and referring clinicians weighing preoperative preparation, the evidence as reported supports earlier continence and better early quality of life; the report says prehabilitation does not appear to prevent long-term incontinence, lessen its severity, or protect erectile function [1].

The report offers a plausible explanation for the erectile finding: dysfunction after prostatectomy is driven largely by injury to the cavernous nerves beside the prostate, and recovery typically unfolds over one to two years, longer than most trials followed participants [1].

## What to watch next

The report identifies open questions about which patients benefit most, the optimal dose and duration of preoperative training, and whether pairing prehabilitation with structured postoperative rehabilitation can extend early gains into lasting recovery [1]. Whether longer or more intensive programs could affect severity was something the included trials were not designed to answer definitively [1].

## Limitations

The authors judged overall risk of bias as moderate using RoB-2, the Cochrane tool for assessing bias in randomized trials [1]. The included trials differed in interventions, comparators and outcome measures, and the authors chose fixed-effects or random-effects models according to observed heterogeneity [1]. This account relies on a news report rather than the full paper, and the report does not give heterogeneity statistics, participant ages, nerve-sparing status or trial locations; the authors reported no funding and no competing interests [1].

## References

1. bioengineer.org. Prehabilitation Before Prostate Surgery Cuts Early Incontinence and Boosts Quality of Life, Meta-Analysis Finds. Accessed October 13, 2026. https://bioengineer.org/prehabilitation-before-prostate-surgery-cuts-early-incontinence-and-boosts-quality-of-life-meta-analysis-finds/