Post-prostatectomy urinary incontinence (PPI) significantly impacts the quality of life (QoL) of patients undergoing robot-assisted radical prostatectomy (RARP). While pelvic floor muscle training (PFMT) is the first-line treatment, options for mild-to-moderate incontinence refractory to rehabilitation are limited, as invasive procedures like urethral slings are often not indicated. The aim of this study was to evaluate the safety and efficacy of a specific radiofrequency (RF) protocol in patients with residual PPI.

We enrolled 20 patients who underwent RARP for prostate adenocarcinoma at least one year prior, presenting with persistent mild-to-moderate incontinence (assessed via pad test) despite having completed at least 10 sessions of PFMT (Kegel, biofeedback, and probe stimulation) without benefit. The experimental protocol consisted of 15 RF sessions divided into two phases (external and endocavitary).
•	Sessions 1-10: 1) External: static automatic mode (500 kHz, 10 min); 2) Endocavitary: dynamic neutral mode (athermal 1, 450 kHz, 10 min).
•	Sessions 11-15: 1) External: static automatic mode (500 kHz, 10 min); 2) Endocavitary: dynamic neutral mode (continuous, 500 kHz, 10 min).
Treatment parameters monitored included impedance (Ohm), instantaneous output voltage (Vrms)—titrated based on patient tolerance—and total energy transferred (Jtot). Clinical outcomes were assessed via PC-test, pad test, tissue quality evaluation, PSA levels at 6 months, and QoL questionnaires.

The treatment was well-tolerated by all patients with no adverse oncological events (stable PSA). We observed a progressive improvement in tissue impedance, which stabilized at approximately 50 Ohm by the end of the protocol. There was a significant improvement in tissue quality and PC-test scores.

Regarding continence recovery:
•	4 patients (20%) achieved complete resolution of incontinence.
•	14 patients (70%) reported improved QoL and reduced pad use.
•	2 patients, who entered the study with moderate-to-severe incontinence (off-label indication for comparison), did not benefit and were subsequently referred for surgical sling/sphincter implantation.

Radiofrequency appears to be a safe and viable "middle-ground" therapeutic option for patients with mild post-RARP incontinence who have failed traditional rehabilitation. By improving tissue impedance and quality, RF can bridge the gap between conservative management and invasive surgery. Further studies are needed to standardize Vrms titration based on individual tissue response.

Lord, H. E., et al. Transurethral radiofrequency energy collagen micro-remodeling for the treatment of female stress urinary incontinence.
Ficarra, V., et al. (2012). Retrospective and prospective studies reporting perioperative outcomes of robot-assisted radical prostatectomy. European Urology.
Sadeghi-Nejad, H. (2007). Radiofrequency energy for the treatment of stress urinary incontinence. International Journal of Impotence Research.

Continence 19S (2026) 102774
DOI: 10.1016/j.cont.2026.102774