Uleri Alessandro, Potiron Eric, Miaadi Naoufel, Pasticier Gilles, Martini Alberto, Deffar Nordine, Vuong Nam-Son, Gourtaud Gilles, Pradère Benjamin, Mroueh Lara, Malavaud Bernard, Baboudjian Michaël, Beauval Jean-Baptiste, Rouffilange Jean, Brureau Laurent, Ploussard Guillaume, Dariane Charles, de la Taille Alexandre
Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, Nantes, France.
Urology Department, Clinique Urologique Nantes Atlantis, Nantes, France.
Prostate Cancer Prostatic Dis. 2025 Sep 19. doi: 10.1038/s41391-025-01026-y.
Digital perioperative programs offer promising solutions to overcome organizational constraints of traditional prehabilitation, potentially improving recovery while reducing healthcare burden and costs. We aimed to assess the impact of adding a surgery-specific module to an optimized digital perioperative program on improving functional outcomes after radical prostatectomy (RP).
This was a multicentre, prospective, comparative, non-randomized trial including consecutive robot-assisted RP. Intervention was the implementation of the Betty (Better Surgery) coaching program combined with the activation of a RP-specific pre- and rehabilitation module. The primary endpoint was continence recovery, defined as "0 or 1 safety pad per day" at 6 weeks after surgery. Secondary endpoints were mid-term continence, need for postoperative physiotherapy, erectile function, complications, and readmissions.
A total of 177 and 156 RP cases were included in the control and experimental groups. Baseline and pathological variables were statistically comparable between groups. The mean patient age and PSA were 65.3 years and 11 ng/ml, respectively. At 6 weeks after RP, 83.3% of patients following the digital program were continent, as compared with 68.4% in the control group (p = 0.002). The need for postoperative physiotherapy for persistent incontinence was significantly reduced in the digital program group (27.5%, versus 58.8%, p < 0.001). Patients who followed the digital program experienced lower complications although not statistically significant (p = 0.1), unplanned visits (p = 0.025), reoperation rates (p = 0.025), more same-day discharge surgery (p = 0.030), and higher satisfaction (9.4/10 versus 8.3/10, p < 0.001). The main limitation was the absence of randomization.
Besides the benefits provided by the perioperative digital program, the addition of a pre- and rehabilitation module, including surgery-specific content, significantly improved functional recovery after RP and perioperative outcomes.
数字化围手术期项目为克服传统术前康复的组织限制提供了有前景的解决方案，有可能在减轻医疗负担和成本的同时改善恢复情况。我们旨在评估在优化的数字化围手术期项目中增加特定手术模块对改善根治性前列腺切除术（RP）后功能结局的影响。
这是一项多中心、前瞻性、比较性、非随机试验，纳入连续的机器人辅助RP病例。干预措施是实施贝蒂（更好的手术）指导项目并激活特定于RP的术前和康复模块。主要终点是控尿恢复，定义为术后6周时“每天使用0或1个安全护垫”。次要终点包括中期控尿、术后物理治疗需求、勃起功能、并发症和再入院情况。
对照组和实验组分别纳入了177例和156例RP病例。两组间基线和病理变量在统计学上具有可比性。患者的平均年龄和前列腺特异性抗原分别为６５.３岁和１１ ng/ml。RP术后6周，接受数字化项目的患者中有83.3%实现控尿，而对照组为68.4%（p = 0.002）。数字化项目组中因持续性尿失禁而需要术后物理治疗的情况显著减少（27.5%，对比58.8%，p < 0.001）。接受数字化项目的患者并发症较少，尽管无统计学意义（p = 0.1），计划外就诊较少（p = 0.025），再次手术率较低（p = 0.025），当日出院手术更多（p = 0.030），且满意度更高（9.4/10对比8.3/10，p < 0.001）。主要局限性是缺乏随机分组。
除了围手术期数字化项目带来的益处外，增加包括特定手术内容的术前和康复模块显著改善了RP后的功能恢复和围手术期结局。
