Continence Recovery After Radical Prostatectomy: Personalized Rehabilitation and Predictors of Treatment Outcome

<b>Background/Objectives</b>: Urinary incontinence (UI) remains a common and distressing complication following radical prostatectomy (RP). This prospective observational study aimed to assess the effectiveness of structured pelvic floor rehabilitation and to identify clinical and surgical predictors of continence recovery. <b>Methods</b>: A total of 182 patients undergoing RP received standardized physiotherapist-guided pelvic floor muscle training (PFMT), including supervised sessions before and after surgery, as well as individualized home exercise programs. UI severity was evaluated using a 1 h pad test and a four-level UI stage classification at three time points. The primary outcomes were changes in UI stage and the achievement of full continence, defined as a pad test result ≤2 g. <b>Results</b>: Following three rehabilitation sessions, 80.2% of patients regained full continence. Preoperative PFMT (β = -1.27, <i>p</i> = 0.0061) and shorter time to rehabilitation (β = -0.04, <i>p</i> = 0.0026) were associated with greater improvement in continence outcomes. Patients treated with robot-assisted RP showed a higher probability of continence recovery compared to those undergoing laparoscopic RP, particularly in the presence of moderate to severe baseline incontinence. Higher baseline urinary leakage significantly decreased the odds of treatment success (β = -0.01, <i>p</i> = 0.0001). ISUP grade and extraprostatic extension were not independently associated with outcomes. <b>Conclusions</b>: Despite the absence of a control group, this study demonstrates the effectiveness of structured and personalized pelvic floor rehabilitation in improving post-RP continence. Early initiation and preoperative training should be prioritized to optimize recovery in routine clinical practice.