Part 3 – Prostatectomy: Rehabilitation Assessment and Treatment Considerations

Part 2 – Rehabilitation Assessment and Treatment Considerations

Recovery from a radical prostatectomy is a considerable challenge for many men. Treatment is multidisciplinary, typically primarily through the urologist with medications and the physical therapist with physical interventions. This article provides basic guidelines for the rehabilitation process.

As with all patients, obtaining the baseline is essential. On the first visit it is important to find out how the patient’s life is affected. Below are items that should be queried and details that are important to obtain about the items. 

 Incontinence- Determine if they are already using a pad and how many pads they use throughout the day. Determine when they leak (i.e. only with certain movements, at night, throughout the day, etc.).

Erectile function-  This is important regardless of sexual activity, but also understanding their sexual activity goals so you can measure progress in ways that are important to him. Questions should be asked about any erectile function. Either ask verbally or have them fill out the Erectile Hardness Scale which grades the quality on a 4-item scale. Also ask about whether any erectile activity is happening while sleeping. 

Examination

The objective examination may need to look at a number of things. The following is a sample of items that should be evaluated:

Functional movement limitations- Gross limitations in movement that would affect any functional goals. These findings may or may not be related to the surgery. 

Hip strength- Hip flexion, abduction, adduction, extension, internal, and external rotation strength can all affect pelvic function. 

Pelvic floor function- This is essential to evaluate which can be measured either with ultrasound imaging or intrarectally. Time frame to perform a digital rectal exam should be cleared by the surgeon since it depends on the quality of tissue which is affected by the type of surgery and whether radiation was performed or not. 

Treatment

As with all conditions, treatment should be based on findings. Below are common options:

Pelvic floor muscle training- Pelvic floor contractions (commonly called Kegel’s) should be able to be coordinated with breathing and endurance holds should also be trained. 

Hip exercises- Resisted hip exercises, particularly rotational movements is important to train and strengthen. 

Erectile function- Obtaining erections is important for improving blood flow and improving strength. Vacuum erection devices (aka penis pumps) are just one way to obtain erections. Medication is sometimes used as well, but discussion with the urologist is essential as some do not want to use medication up to 6 months post-prostatectomy. 

In this three part series a patient’s experience with a radical prostatectomy is reviewed, what occurs during surgery, and rehabilitation after surgery. The key to treatment for this population, as with all patients, is to personalize care and to address not only the biomedical aspects, but the psychological and social aspects of their life as well. 

References

Goldstein, I. et al. “The erection hardness score and its relationship to successful sexual intercourse.” The journal of sexual medicine 5 10 (2008): 2374-80 .

Jordre, Becca, and William Schweinle. “Comparing resisted hip rotation with pelvic floor muscle training in women with stress urinary incontinence: a pilot study.” Journal of Women’s Health Physical Therapy 38.2 (2014): 81-89.

Bratu O, Oprea I, Marcu D, et al. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician. J Med Life. 2017;10(1):13-18.

Author: Nick Rainey, PT, DPT

Author Bio: Dr. Nick Rainey, PT, DPT is an Academy of Pelvic Health Physical Therapy member who is Board-Certified Clinical Specialist in Orthopaedic Physical Therapy. He is the owner of Rainey Pain & Performance, P.C., co-founder- Functional Pain Management Society. Nick is a Fellow of the American Academy of Orthopaedic Manual Physical Therapy and Certified Cervical & Temporomandibular Therapist (CCTT) by the Physical Therapy Board of Craniofacial & Cervical Therapeutics (ptbcct.org). He is a Certified Strength and Conditioning Specialist and has competed in the USA Weightlifting Sports Performance Coach Level 1.