Author: Dr. Daniela Moise, DPT – Advance Core Physical Therapy and Wellness 5300 N Lincon Ave, Unit A, Chicago , IL
Patient Profile
- Age: 61
- Procedure: Robotic-assisted radical prostatectomy
- Presenting Concerns: Postural changes, pelvic floor dysfunction, risk of incontinence and sexual dysfunction
Pre-Operative Intervention (8 weeks prior)
Goal: Prepare the pelvic floor and global body systems for optimal post-op recovery.
Interventions included:
- Real-time ultrasound biofeedback for external urinary sphincter training
- Breathing techniques to improve diaphragm-pelvic floor synergy
- Hypopressive abdominal techniques to reduce intra-abdominal pressure
- TECAR therapy applied to stimulate microcirculation, support lymphatic flow, boost cellular metabolism, and promote collagen production, contributing to enhanced tissue resilience and muscle regeneration.
- Visceral mobilization targeting the left kidney, mesenteric root, and associated digestive fascia to enhance fascial mobility and function, supporting prostate health and optimizing pelvic-visceral dynamics
- Rib cage release and postural awareness training
- Lower extremity mobility to improve pelvic control
Post-Operative Rehab (Initiated 10 Days After Surgery)
Main complaints: Mild urinary leakage, shallow breathing, pelvic heaviness.
Treatment focused on:
- Scar tissue mobilization and visceral manipulation to reduce fascial restrictions
- Continued use of TECAR therapy and visceral mobilization to accelerate healing and reduce adhesions
- Reintegration of breath-led pelvic floor activation
- Hypopressive exercises and core optimization strategies
- Rib mobility techniques, spinal alignment, and postural retraining
- Joint and fascial mobilization for the lesser pelvis, addressing hip mobility and ligamentous support to optimize function and relieve restrictions
- Functional pelvic floor coordination through Ultrasound real-time feedback
Outcomes (By 12 Weeks Post-Op)
- Full urinary continence, including during high-demand tasks
- Improved erectile function and restored sexual confidence
- No reported pelvic pain, constipation, or abdominal discomfort
- Normalized bowel function and abdominal motility
- Improved rib expansion and upright posture
- Positive quality of life reports and functional return to daily activity
Conclusion
This case supports the hypothesis that a multimodal, integrative pelvic physical therapy program that initiated before and continued after prostatectomy, may significantly improve continence, sexual function, pain outcomes, and postural recovery.
