Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Redcliffe hospital has been providing prehabilitation prostatectomy classes since 2023 and this review was conducted to evaluate the effective and patient satisfaction with this class.
Dates: March 2025 - February 2026
Implementation sites: Redcliffe Hospital
Aim
This quality improvement review was conducted to evaluate the impact of group education and individualised ultrasound-guided pelvic floor exercises prior to prostatectomy on incontinence rates and severity post-operatively, and evaluate patient satisfaction.
Outcomes
Those who attended the pre-operative class had an overall reduced incontinence severity compared with those who did not attend the class. 19.0% of those who did not attend the class reported no incontinence, while 36.7% who did attend, reported no incontinence showing an improved rate of continence. - There was also a reduced requirement for post-op continence nurse (p=0.018) and physiotherapy appointments (p=0.25). There was no difference in re-presentation rates, failed-to-attend rates or length of hospital stay. - Excellent patient feedback with an overall satisfaction rating of 4.89/5 (n=61).
Key themes identified; comprehensive information, presentation quality, group interactions, multidisciplinary input and supportive and approachable staff.
Background
A pre-operative class for prostatectomy patients (Pre-Prostatectomy Continence Clinic (PPCC) was implemented at Redcliffe Hospital in March 2023, with the aim to provide pre-surgery education and resources to reduce post-operative incontinence and time to continence. The class focuses on pelvic floor exercises, anatomy, catheter care, and how to manage incontinence if it occurs. This quality improvement review was designed to evaluate the impact of group education and individualised ultrasound-guided pelvic floor exercises prior to prostatectomy on incontinence rates and severity post-operatively.
Methods
An innovative, multidisciplinary program delivering pre-operative pelvic floor exercises and pre-operative education, was implemented at Redcliffe Hospital (Australia) in March 2023. The program was designed to capture all patients who have prostate cancer and were planning to have surgery as the treatment. The program included a group education session running for 45 minutes followed by individual transperineal real-time ultrasound guided pelvic floor muscle exercises. The group class was capped at five participants per class, and a structured PowerPoint presentation was delivered with the opportunity for discussion and questions from participants. The presentation discussed healthcare rights, the care journey, expectations of urinary incontinence, incontinence aids, catheter care, anatomy changes and pelvic floor exercises as well as sexual function. All participants were provided with a take-home pack of written information and sample continence aids.
The individual transperineal real-time ultrasound was conducted in a private room by a senior pelvic floor physiotherapist, with informed consent, and allowed the participant to practice the exercises with real-time feedback. The physiotherapist encouraged movement of the striated urethral sphincter and the bulbocavernosus rather than posterior activation leading to better anterior control for anticipated urinary incontinence. Cues can be used to encourage activation with the most common cues being ‘stop the flow of urine’, ‘imagine a drawing in action as if drawing a turtles head into the shell’, ‘nuts to guts – imagine entering a cold body of water whereas the scrotum touches the cold water and the testicles draw in and lift’. An individual home exercise program was prescribed with written instructions. Based on existing research, the physiotherapist recommends a minimum of three to six sets of 10 repetitions with up to a 10 second hold per day. After the class and ultrasound, participants were invited to provide anonymous feedback via a two-minute survey (QR code or written and handed back to administration). Those who chose not to attend the ultrasound, were also provided with the opportunity
to provide feedback via the form.
Discussion
This project requires an experienced senior pelvic floor physiotherapist and an experienced Registered/Clinical Nurse. A private room is needed at regular clinic times (twice a month), with the room being large enough for up to 5 participants and their support people. The room should support audiovisual aids such as PowerPoint presentations. Free continence aid packs can be ordered from a number of companies, which can be provided at the class for patients to take home. A small amount of printing is required (approximately five pages per patient) to allow for reflection on class content. Some limitations of this review include; Incontinence severity was measured at the first doctor’s appointment, approximately six weeks post-operatively, which captures early recovery but not long-term continence outcomes. Pad usage, while clinically practical, is a patient-reported measure and may lack standardisation. Additionally, adherence to prescribed home exercise programs was not objectively measured, limiting interpretation of dose–response relationships. A prospective design with a longer follow-up period would be important for future research in this area.
Some limitations of the class include:
- The initial cost to set up the class may be prohibitive to some facilities. A real-time ultrasound has an approximate cost of $10,235 (Mindray DP-50 Expert Ultrasound Machine) however it is versatile and able to be utilised for other purposes across an outpatient setting. Although the class is run once a fortnight on a Wednesday afternoon (reduced flexibility), patients were motived to attend and this was not prohibitive.
- Implementation of the Pre-Prostatectomy Continence Clinic at Redcliffe Hospital was associated with improved early post-operative continence outcomes and high patient satisfaction, without increasing adverse events. Attendance more than three weeks prior to surgery was associated with better continence outcomes, reinforcing the importance of timely prehabilitation.
This quality improvement initiative supports the integration of structured group education and ultrasound-guided pelvic floor training into standard prostatectomy care pathways to enhance recovery and patient experience. This model of care can be duplicated and implemented in all Queensland Health Facilities who offer prostatectomy surgery for prostate cancer treatment.
References
(1) Australian Institute of Health and Welfare (AIHW). Cancer in Australia. Canberra.
2021 Cat. no. CAN 144.
(2) Williams I. S. C., McVey A., Perera S., O’Brien J. S., Kostos L., Chen K., Siva S., Azad A. A., Murphy D. G., Kasivisvanathan V., Lawrentschuk N., Frydenberg M. Modern paradigms for prostate cancer detection and management. Medical Journal of Australia. 2022. 217 (8): 381- 434. DOI:10.5694/mja2.51722
(3) Mungovan S. F., Carlsson S. V., Gass G. C., Graham P. L., Sandhu J. S., Akin O., Scardino P. T., Eastham J. A., Patel M. I. Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nat Rev Urol. 2021; 18(5): 259–281. DOI: 10.1038/s41585-021-00445-5
Key contact
Jessica Morris
Clinical Nurse Consultant
Redcliffe Hospital
Metro North HHS