Telerehabilitation and telemonitoring protocol after full anatomical prostatectomy: description of surgical technique, platform development and functional results

Introduction. Prostate cancer is the 4th most common cancer worldwide. Radical prostatectomy is the first-choice therapy for localized PCa. Despite advancements in surgical techniques, urinary incontinence and sexual impotence are common consequences of robot-assisted radical prostatectomy. Surgeons have developed techniques to minimise functional sequalae. Additionally, extensive research highlights the importance of monitoring and intensive postoperative rehabilitation protocols in promoting the recovery of these functions. Therefore, our Division collaborated with AbMedica to develop a telemonitoring and telerehabilitation module for RARP patients, integrated into the MAIA platform. This thesis aims to evaluate the feasibility and efficacy of our new RARP technique that preserves periprostatic anatomical structures to improve functional outcomes and assess the feasibility and efficacy of our new platform for postoperative rehabilitation and monitoring following RARP with the new technique. Methods. The study enrolled 227 patients with localized PCa who underwent RARP with our new technique between April 2022 and January 2023. They were divided into 2 groups: group A (140 pts) received standard hospital discharge rehabilitation and monitoring, group B (87 pts) received standard of care plus telerehabilitation and telemonitoring comprising daily virtual guidance for pelvic floor muscle training, adherence reporting, notifications for PDE5i intake and PAD test performance every 3 days. Pre-, intra-, post-operative, and pathological variables were analyzed. Continence and potency were assessed using validated questionnaires at 1 week, 1 and 3 months after catheter removal for group A and weekly for group B via the App. Results. In group A, continence rates were 74.2%, 80.7% and 91.4%, while potency rates were 10.7%, 34.2% and 47.8% at 1 week, 1 and 3 months after catheter removal. Continence rates were comparable to those obtained with the hood technique (a similar modification of the anterior approach with anterior and posterior reconstruction) but data on potency recovery are lacking. Both techniques demonstrated similar complication (8.5% vs 9.7%) and positive surgical margin rates (21% vs 20%). If compared with the posterior approach, the latter had higher rates of positive surgical margin (25% vs 21%). Patient and healthcare provider satisfaction with the MAIA platform was high. Telemonitoring facilitated timely identification of patients with abnormal pad test results however, continence recovery rates were similar between groups A and group B at 1 and 3 months. Potency recovery rates were higher in Group B at 1 and 3 months (p0.03). After stratification based on nerve-sparing technique, only the full NS group showed higher potency rates in Group B (p0.02). Multivariable regression analysis confirmed the nerve-sparing approach and the use of the MAIA platform as predictors of potency recovery at 1 and 3 months. In group B adherence to the telerehabilitation protocol was high, and non-adherent patients were invited for a televisit to identify the reasons for non-adherence. Consequently, they had a statistically significant median gain of 35 and 21 days for resumption of PFMT and PDE5i rehabilitation protocol respectively compared to group A. Conclusions. Our anatomical RARP technique showed promising early recovery of functional outcomes without compromising oncological outcomes or safety. The use of the MAIA platform was user-friendly and satisfying for both patients and medical doctors. Intensive telemonitoring of adherence to the telerehabilitation protocol through the platform led to higher rates of early potency recovery.