RESEARCH PAPER

Efficacy of tele-nursing consultations

in rehabilitation after radical
prostatectomy: a randomised
controlled trial study
Bente Thoft Jensen, Susanne Ammitzbøll Kristensen, Sofie Vistoft Christensen
and Michael Borre

ABSTRACT
The dramatic increase in prostate cancer incidence causes higher demands for public health care. To meet
these demands, fast track pathways have been introduced in radical prostatectomy. However, the short
length of hospital admission leaves less time for patient education. The aim of this study was to investigate
whether nurse-led telephone consultations (TCs) could optimize resources and secure rehabilitation and patient
satisfaction in the post-operative period. This study is a prospective randomized controlled trial. A random
sample of 95 consecutively enrolled patients was randomized to either intervention or standard follow-up.
The intervention was an additional TC 3 days post-operatively. The care and patient education offered during
hospitalization was similar for all patients. Randomization took place at discharge and was controlled externally.
Data were collected from medical records and questionnaires 2 weeks post-operatively. We found no difference
in the overall efficacy regarding patient satisfaction, sense of security and post-operative discomfort. Some
patients had unmet needs and TCs provided better rehabilitation regarding management of bowel function, pain,
catheter and wound care. There was no difference in the need of post-operative contact to other health care
affiliates. In general, patients were sufficiently educated in managing early rehabilitation and they expressed
high satisfaction and sense of security in the post-operative period after discharge regardless of TC. Therefore,
TCs will not be the standard procedure, but the results have increased awareness in daily clinical practice
and optimized the clinical pathway in general. The results indicate commitment and high adherence to clinical
guidelines among the nursing staff.
Key words: Clinical Effectiveness • Evidence-based practice • Nursing research • Prostate cancer •
Quality of care • Rehabilitation

INTRODUCTION In modern surgical care, it is advisable to manage

Prostate cancer is the most common cancer in
men in most western countries (Heidenreich et al.,
2010). The crude annual incidence in the European
Union is 78·9/100 000 men and the mortality rate is
30·6/100 000/year (Heidenreich et al., 2010).
Authors: BT Jensen, MPH-PhD.-Stud, Urology Department, Aarhus
University Hospital, Aarhus, Denmark; SA Kristensen, RN-MSc-Stud,
Urology Department, Aarhus University Hospital, Aarhus, Denmark; SV
Christensen, RN, Urology Department, Aarhus University Hospital, Aarhus,
Denmark; M Borre, Professor-MD, PhD, Urology Department, Aarhus
University Hospital, Aarhus, Denmark
Address for correspondence: Bente Thoft Jensen, Urology
Department, Aarhus University Hospital Skejby, Aarhus, Denmark
E-mail: thoft@c.dk
patients within an enhanced recovery protocol (Kehlet,
2011). However, fast track pathways are not very well
implemented in urology care except in radical prostate-
ctomy (Kehlet, 2009, 2011; Kehlet and Wilmore, 2010).
Radical prostatectomy patients are hospitalized
between 24 h when undergoing robot-assisted laparo-
scopic radical prostatectomy (RALP) and 2–3 days
undergoing conventional open retro-pubic radical
prostatectomy (RRP) (Tewari et al., 2003). Generally,
robot-assisted surgery leads to fewer post-operative
complications and thus a reduced length of hospital
stay (Menon et al., 2005). Use of the RALP method
has spread rapidly across Europe during the past
years. The short admission time has put pressure on

© 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd
International Journal of Urological Nursing 2011 • Vol 5 No 3 123
 Rehabilitation after radical prostatectomy
services at ward level. It has caused nursing staff
to be concerned if existing rehabilitation programmes
sufficiently cover patients’ needs for information and
education (Anderson, 2010).
Fast track pathways can lead to post-discharge
problems. Therefore, patient education is mandatory to
provide patients and relatives with skills and knowledge
to manage potential post-surgical complications and
care in the patient’s own home (Inman et al., 2011).
These factors could have a major impact on patient
satisfaction and safety (Shaida et al., 2007b).
The increased workload from diagnosis and treat-
ment of patients with prostate cancer has given rise to
public awareness and discussions among profession-
als concerning rehabilitation. This places significant
demands on health care establishments for improve-
ments in service to maintain quality (Shaida et al.,
2007b; Anderson, 2010). In a time with reducing
resources, it is of great importance that nursing staff
investigate their ongoing practice, understand patient
expectations and are motivated for making adjust-
ments. It is crucial to ensure an appropriate follow-up in
uro-oncology care because of the relatively short con-
tact time with patients. Different interventions across
settings aim to secure and optimize rehabilitation in
patient pathways. Studies have indicated that nurse-
led telephone follow-up is an effective approach to
meet needs after discharge and increase patient sat-
isfaction (Booker, 2004; Cox, 2008). Patients are
reported to be receptive to nurse-led service and tele-
phone follow-up (Anderson, 2010) and overall patient
satisfaction is reported to be high after nurse-led tele-
phone follow-up (Overend et al., 2008). In prostate
cancer, patients undergoing radical radiotherapy for
example, nurse-led telephone follow up is an accept-
able alternative to an out-patient visit and a way to
maintain quality and optimize use of specialized nurses
(Faithfull et al., 2001). In summary, telephone consul-
tations (TCs) have been shown to be an innovative
professional alternative to conventional out-patient vis-
its. Patients report TCs are less stressful, they increase
patient satisfaction and provide significant improve-
ments in service delivery. However, a recent Cochrane
review of telephone follow-up including more than 33
randomized controlled trials (>5000 patients) assess-
ing the effects of TC initiated by hospital-based health
professionals (Mistiaen and Poot, 2006) reported that
the effect of TC was low and inconclusive. A com-
prehensive literature search was performed in this
study and later updated and only one study has so
far evaluated the efficacy of an early nurse-led tele-
phone intervention to optimize rehabilitation outcome
and reduce morbidity in the post-operative period after
radical prostatectomy (Inman et al., 2011).
124 © 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd
AIM
The aim was to investigate the efficacy of TCs in the
immediate post-operative period after fast track radical
prostatectomy.
Hypotheses
• TCs optimize rehabilitation outcome after radical
prostatectomy
• TCs ensure subjective patient satisfaction
Endpoints
• Subjective patient satisfaction and sense of
security
• Patient-reported rehabilitation outcome in the
domains of catheter-management, post-operative
wound care, pain, bowel function and activities of
daily living (ADL) after discharge.
MATERIALS AND METHODS
Design
This study is a prospective randomized controlled trial.
Sample
To our knowledge, no previous studies were applicable
to the research questions of this study. Therefore, it
was not possible to apply previous results and calculate
sample size and power.
Study population
The study encompassed 142 men with prostate cancer
referred for radical prostatectomy in the period from 1
November 2008 to 30 November 2009.
The inclusion criteria were men referred for radical
prostatectomy by either RRP or RALP. The surgeries
were performed by an international recognized sur-
geon in each field, one for RRP and one for RALP,
respectively. The surgeries were all conducted in the
same urology centre. All patients were enrolled in
a national clinical database on surgical treatment of
prostate cancer. Patients discharged later than 4 days
post-operatively were excluded.
Patient education
Evidence-based standard care programmes are devel-
oped nationally (Rigshospitalet, Enhed for Perioperativ
Sygepleje, 2011) ensuring that all patients are edu-
cated equally before randomization. The education
programme provides initial awareness of potential
post-surgical problems and the patient must have a
clear understanding of how to manage post-surgical
issues when discharged. The education programme
includes catheter hygiene care, correct catheter

function, positioning of penis and management of
urine bags. Patients are also introduced to prevention
strategies and symptoms of urinary infections. Pain
control and administration of analgesics are empha-
sized in order to reduce surgical stress as one of the
cornerstones in fast track methodology. Post-surgical
nutritional care and optimizing of bowel function are
in focus as well as the importance of physical activity
and general restrictions. Moreover, patients are intro-
duced to wound care as well as symptoms of wound
infections. At discharge, all patients receive oral and
written information of the above issues related to early
rehabilitation.
Randomization
At discharge patients were randomized to either TC
or standard care. The randomization process was
controlled by an external data management company.
Block randomization was carried out securing the study
population reflected the distribution of patients to open
versus robot-assisted surgery in daily clinical practice.
The intervention group encompassed 46 (15 RRP/31
RALP) patients randomized to TC and a control group
of 49 (17 RRP/32 RALP) patients received standard
care. In total, 47 patients were excluded because they
declined participation or the length of post-operative
stay was prolonged (>4 days). In all, 95 patients were
included in the study: 32 received RRP and 63 received
RALP, respectively (Figure 1).
Start: 142 Patients
47 Patients excluded
End: 95 Patients
32 open 63 robot -
surgery assisted surgery
Randomisation Randomisation
15 + 17 – 31 + 32 -
Tele tele tele tele
Figure 1 Flowchart.
© 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd
Rehabilitation after radical prostatectomy
Intervention
TC was performed 3 days after discharge and man-
aged by two clinical nurse specialists. The duration of
TC was standardized to 15 min but prolonged in case
of special needs. A manual was used to standardize
the TC as a semi-structured interview.
Data collection
All patients filled in questionnaires designed for the
study. Data were collected 2 weeks post-operatively at
the first visit in the out-patient clinic.
The questionnaire was divided into sub-sections in
accordance with the domains and endpoints of this
study. Patient experience was ranked in categories
using a Likert format. As an example: ‘Did you expe-
rience any problems in managing your urine bag?’
Yes/no. ‘If yes, to which extent?’ To a great extent,
to a certain extent or to a less extent. At the end
of each subsection, the patient was asked to score
the overall degree of discomfort regarding the specific
domain and its impact on daily living on a visual ana-
logue scale (VAS). Demographic variables like age,
social and marital status were extracted from medi-
cal records. Data on length of stay (LOS) and time
with catheter were extracted from the public university
hospital administration registry.
Pilot study
A pilot study was performed including 10 patients
testing the semi-structured interview manual and the
questionnaire design. To perform an internal validation
of the questionnaire, a test–re-test was conducted.
Patients were asked twice within 2 weeks to fill in the
questionnaire. All patients returned the questionnaire
and a high agreement of 80% was found. All patients
recommended TC. The study group concluded the face
and construct validity was acceptable.
ETHICS
After obtaining institutional review board approval, the
study was approved by the National Ethics Committee
and a standard procedure was followed concerning
written and oral information and informed consent. The
study was approved by the National Data Protection
Agency. This study was a quality assurance study and
the intervention was considered non-maleficent to the
patient as the intervention was an additional service
compared to standard procedure. Initially, the inter-
vention was expected to be beneficent for patients
by improving rehabilitation in the early post-operative
period. According to the study design, the intention was
to ensure highest possible veracity and transparency
in order to clarify the hypotheses.
125
 Rehabilitation after radical prostatectomy

Transport costs in connection with control visits were

Table 1 Patient characteristics in the intervention and control groups
refunded and sampling of data took place at days
where the patient already had an appointment for a
Intervention group Control group
control visit at the hospital. As randomization took
Patient characteristics (n = 46) (n = 49)
place at discharge all patients received the same treat-
ment and care during hospitalization. There were no Time with catheter [mean days 12·4 (11·7–13·1) 13·0 (12·5–13·6)
extra costs involved or time the patients had to spend (95% CI)]
participating in the project except the 15 min phone Age [mean years (95% CI)] 64·1 (62·5–65·8) 62·5 (60·9–64·2)
call in the intervention group. The present standard Length of stay [mean days (95% CI)]
care offered to these patients post-operatively justified Open surgery 1·9 (1·6–2·2) 2·1 (1·8–2·3)
Robot-assisted surgery 1·2 (1·0–1·3) 1·1 (1·0–1·2)
randomization.
Marital status – living with spouse 97·6 (87·4–99·9) 88·5 (76·7–95·6)
[% (CI)]

ANALYSES AND STATISTICAL METHODS CI, confidence intervals.

Efficacy was primarily expressed as the difference
between the intervention and the control group Table 2 Differences in post-operative discomfort in the two groups analysed
regarding patient satisfaction and sense of security. with Fisher’s χ 2 test
Secondly, by the differences in the domains catheter-
management, post-operative wound care, pain control, Intervention Control
bowel function and ADL after discharge. Missing data Post-operative discomfort group N (%) group N (%) P-value
were only observed in two persons (one in each group)
Satisfaction 49 (100) 45 (97·8) 0·48
and was not believed to influence the analysis.
Sense of security 44 (89·8) 41 (89·1) 1·00
Catheter
Statistics Leaking 33 (67·4) 33 (71·7) 0·66
Characteristics like age, LOS, marital status and time No urine in bag/catheter stop 5 (10·2) 4 (8·7) 1·00
with catheter were described. Normally distributed data Problems placing urine bags 7 (14·9) 5 (10·9) 0·76
were described with mean, standard deviation and 95% Problems handling urine bags 6 (12·2) 2 (4·4) 0·27
confidence intervals (CI) and tested with Student’s t- Hematuri 34 (69·4) 23 (52·3) 0·14
test. Frequencies were compared by Fischer’s exact Fever 4 (8·2) 2 (4·4) 0·68
Use of antibiotics 4 (8·3) 6 (13·6) 0·51
test. Multivariate analyses were performed with logistic
Wound
regression with patient satisfaction as the dependent
Need of assistance to change 17 (34·7) 16 (36·4) 1·00
variable. Multivariate model-fit was performed. Asso-
appliance
ciations were reported as odds ratios and 95% CI. Reddening 15 (30·6) 9 (20·0) 0·34
P-values <0·05 were defined as statistically significant. Discolouration 22 (44·9) 28 (62·2) 0·10
Leakage from wound 21 (42·7) 21 (46·7) 0·84
Bowel function
RESULTS Constipation 22 (44·9) 16 (34·8) 0·40
Due to the randomization, the distribution of age, LOS, Diarrhoea 12 (24·5) 11 (23·9) 1·00
marital status and length of catheterization were well Pain
matched in both groups (Table 1). From wound 25 (52·1) 16 (34·8) 0·10
There were no differences between the two groups From urethra 29 (60·2) 26 (56·5) 0·83
From rectum 21 (43·8) 27 (58·7) 0·16
regarding satisfaction, sense of security and post-
Reducing medicine 18 (37·5) 13 (28·3) 0·39
operative discomfort (Table 2). A majority of patients
Limitations in ADL:
reported post-operative discomfort, but the distribution
Regarding hygiene 13 (27·1) 7 (15·2) 0·21
was equal in both groups. Almost 70% had leaking Regarding getting dressed 22 (45·8) 17 (37·0) 0·41
problems and constipation was present in an average At home 29 (60·4) 27 (58·7) 1·00
of 40% in both groups. More than 50% reported pain Out of home 36 (75) 31 (67·4) 0·50
from different locations and 75% reported to be limited When socializing 8 (16·3) 10 (21·7) 0·60
in performance of activities outside the home (Table 2). Regarding sleeping 28 (57·1) 22 (47·8) 0·41
However, only 26% reported the need of assistance Need of assistance 10 (20·8) 12 (26·1) 0·63
from other health care affiliates like home care or Need of more information during 7 (14·6) 7 (15·6) 1·00
general practitioners. admission
Overall, discomfort and limitations in ADL caused ADL, activities of daily living.
by post-operative domains scored low on the VAS

126 © 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd
 Rehabilitation after radical prostatectomy

Table 3 Differences in post-operative discomfort domains in the two groups Table 6 Level of rehabilitation in the intervention group analysed by logistic
analysed with Student’s t-test regression

Post-operative Intervention group (n = 49) N Odds ratios (OR) 95% CI P-value

discomfort on a visual Intervention Control group:
Catheter 41 0·82 0·57–1·18 0·28
analogue scale group: mean (SD) mean (SD) P-value
Wound 40 0·87 0·65–1·15 0·32
Discomfort caused by Bowel function 39 0·76 0·60–0·98 0·03∗
Catheter 4·2 (2·1) 4·7 (2·3) 0·30 Pain 40 0·77 0·57–1·04 0·09
Wound 2·9 (2·2) 2·7 (2·4) 0·57 Activities of daily living 39 1·06 0·82–1·37 0·64
Bowel function 3·6 (3·0) 3·2 (2·8) 0·56
Pain 3·0 (2·5) 2·7 (2·1) 0·55 CI, confidence intervals.
∗ Significant.
Limitations in ADL 4·1 (3·2) 4·7 (3·0) 0·36
Limitations caused by
Catheter 4·8 (3·0) 4·8 (3·1) 0·99 Table 7 Association between need of assistance and co-variables analysed
Wound 3·5 (3·0) 3·1 (2·9) 0·49 by logistic regression
Bowel function 2·0 (2·6) 2·0 (2·7) 0·91
Pain 2·5 (2·5) 2·7 (2·7) 0·79 Assistance (n = 94) Odds ratios (OR) 95% CI P-value

ADL, activities of daily living; SD, standard deviation. Surgical modality 3·80 1·01–15·15 0·05∗
Tele-nursing consultation 0·70 0·24–1·99 0·50
Table 4 Association between tele-nursing consultation, patient satisfaction Marital status 1·09 0·60–1·98 0·77
and sense of security analysed by logistic regression Age 0·97 0·88–1·07 0·58
Length of stay 1·24 0·38–4·02 0·70
Time with catheter 0·99 0·77–1·27 0·92
N Odds ratios (OR) 95% CI P-value
CI, confidence intervals.
Satisfaction 94 1·00∗ ∗ Significant.
Sense of security 95 1·07 0·29–3·98 0·92

CI, confidence intervals. reduced by 24%. Clinically relevant reductions were

∗ All replied to be satisfied.
seen in different domains. In catheter care, a reduc-
tion of 18% was reported, a 13% reduction related to
Table 5 Association between tele-nursing consultation and catheter-related
wound care and a 23% reduction related to pain control
discomfort analysed by logistic regression
compared to those who did not find TC useful.
Unmet needs and requirements for supportive assis-
N Odds ratios (OR) 95% CI P-value
tance from other health care affiliates were analysed
Catheter 95 1·11 0·92–1·33 0·29 (Table 7). We found no difference in the two groups,
Limited activity 95 1·00 0·88–1·14 0·99 but RALP patients had significantly fewer contacts
Catheter block 95 1·19 0·30–4·75 0·80 compared with RRP patients.
Placement of urine bags 93 1·44 0·42–4·90 0·56
Management of urine bags 95 3·07 0·59–16·06 0·18

CI, confidence intervals. DISCUSSION

(Table 3). However, catheter problems and limitations
in ADL were reported as giving relatively modest
discomfort and limitations with a mean score of 4·8
and 4·7 on the VAS, respectively.
There were no differences in the overall efficacy
regarding TC expressed by patient satisfaction and
sense of security (Table 4). Paradoxically, all patients
were satisfied during hospitalization.
It was not possible to document any difference in
domains like catheter care (Table 5).
Despite no difference in the overall efficacy, rehabil-
itation was significantly better in the intervention group
among those who reported TCs as useful (Table 6).
Discomfort related to bowel function was significantly
This study showed a high patient satisfaction in all
pathways regardless of surgical modality and interven-
tion. Similar results were found in a recent study by
Overend et al. (2008). This study found that nurse-
led TCs provided overall high patient satisfaction and
that the concept was well accepted by all patients.
These findings correspond with Booker et al. (2004),
who found that nurse-led TCs were safe, efficient and
an acceptable alternative to traditional follow up in
hospital-based out-patient clinics for cancer patients.
The results from our study confirm earlier find-
ings and could suggest standard procedures are
well implemented. Despite reduced LOS, the patients
reported high patient satisfaction and relatively few
had major post-operative problems (Tables 2 and 3).

© 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd 127
 Rehabilitation after radical prostatectomy
No additional services from other health care affiliates
were necessary in almost all pathways.
Several studies by Kehlet et al. have documented
that fast track pathways provide increased patient out-
come and reduced post-operative morbidity and that
fast track pathways will become the standard also in
urology (Kehlet and Wilmore, 2010). However, critics
of fast track pathways claim that some of the health
care burden could be pushed towards the patients
and their spouses as a result of early discharge (Taub
et al., 2006; Kehlet, 2008). In this study, there was
no difference in patient experience concerning safety
and satisfaction in the two groups. In other words, it
seems of no importance whether patients were offered
TC – all patients felt safe in the post-operative period.
This could suggest that the standardized patient edu-
cation and information programme during admission is
adequate.
An early study by Bostroms from 1996 also reported
no difference in patient satisfaction with or with out
TC after discharge. Despite this, most patients had
a significant need to be supervised after discharge
suggesting that patients were unlikely to actively seek
required information from the hospital. Despite the
unmet needs patients tended to be satisfied with the
care and services trusting the best care was given.
The same phenomenon could explain why this study
found no differences between the intervention and the
control group.
Initially, we hypothesized that TCs would increase
patient satisfaction and reduce post-operative dis-
comfort in the intervention group. This could not
be demonstrated in this study. Contrary to the con-
cern of the nursing staff our results underpinned that
patients in general were sufficiently educated in man-
aging clinical issues post-operatively; thus, TC could
be interpreted as an additional service rather than
a method to improve rehabilitation outcome (Shaida
et al., 2007a). A similar conclusion was drawn by Davi-
son et al. (2004) reporting that TCs were an overuse of
resources because patients were satisfied with the
education and information provided in the existing
discharge programme.
This study showed that patients in the intervention
group were significantly better rehabilitated in the post-
operative period. A clinically relevant reduction was
found regarding discomfort in bowel management and
in catheter-related aspects, wound and pain (Table 6).
In contrast to Davison et al., this study found no dif-
ference between the intervention and control group
concerning assistance from other health care affili-
ates in the post-operative period after discharge. In
other words, the patients did not ask for a second
opinion or reported unmet needs and no additional
128 © 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd
burden seemed to be pushed towards other health
care affiliates. There was a slight difference in needs
for primary care resources showing that RALP patients
had significantly less need for additional contacts.
Unfortunately, we were not able to provide valid infor-
mation concerning differences in costs and need of
supplementary post-discharge contacts to the ward.
Our study provided useful information about patients
in the post-operative period after radical prostatectomy.
We found that some patients had unmet needs and TC
could be one way of optimizing post-operative care.
Compared to recent nurse-led TC studies (Mistiaen
and Poot, 2006; Anderson, 2010; Inman et al., 2011),
this study provided important information concerning
specific nursing domains in the immediate post-
operative period. This knowledge has inspired to
improve the information kit at discharge with special
attention to improve patient skills and competencies
in the domains of bowel function, pain management,
wound and catheter-related problems. However, the
efficacy of TC in this experiment was not convincing.
Moreover, the literature search showed a variety of
different results and was not immediately applicable to
urology nursing aspects and immediate post-operative
patient aspects. On the basis of current evidence, TCs
conducted in this patient group will be considered an
additional service and will not be a standard procedure
(Mistiaen and Poot, 2006). However, trends are
rapidly changing and the TC concept will properly be
further developed. Some departments have introduced
group consultations and interactive internet-based
solutions making it possible to inform and educate pre-
operatively and to interactively communicate directly
with the clinical nurse specialist when needed.
Limitations
No efficacy studies were applicable to the research
questions in this study. Therefore, it was not possible
to calculate a proper sample size and power estimation.
The goal was to include 100 patients in 1 year.
The questionnaire was designed for the study and
therefore not fully validated. However, we did a test–re-
test showing high reliability. In the light of the results
we recognize that it would have been advisable and
appropriate to validate the questionnaire with focus
on content and construct validity. It was not possible
to show the expected difference in post-operative dis-
comfort between the intervention and control group,
respectively; this could be explained by a lack of con-
struct validity.
CONCLUSION
In general, this study confirms that the standard
rehabilitation programme was adequate and patients
 Rehabilitation after radical prostatectomy

were efficiently educated in managing immediate
rehabilitation issues in the early post-operative period
after discharge. Moreover, the patients expressed a
very high satisfaction and sense of security in the
post-operative period after discharge regardless of
TC. TC for this patient group will so far be consid-
ered an additional service and will not be a standard
procedure. There is still room for improvement in
fast track pathways and telemedicine will presumably
play an important role when planning and optimizing
future fast track pathways. However, the evidence in
telemedicine end the efficacy is still sparse and will
require ongoing focus on how this technology should
be fully utilized to facilitate clinical practice. The results
indicate professional commitment and high adherence
among the nursing staff aiming at securing and opti-
mizing rehabilitation after radical prostatectomy.
ACKNOWLEDGEMENTS
The authors gratefully acknowledge the support from
the Department of Urology at Aarhus University
Hospital and the financial support from Danish Society
of Urology Nurses. Finally, we thank Ms Lena Hohwü,
MHSc, Aarhus University for taking the first step to
initiate this study.

WHAT IS KNOWN ABOUT THIS TOPIC

• Advisable to manage patients referred to radical prostatectomy within a fast track protocol
• Trends are changing in surgery and places increased pressure on health care staff regarding appropriate care and follow-up
• TC is a professional alternative to conventional visits in out-patient clinics. Moreover, the personal tailored call is a popular approach among
patients
• Resent Cochrane review of hospital-based TCs reported the effects of TCs as inconclusive.

WHAT THIS PAPER ADDS

• TC has no overall efficacy related to patient satisfaction, sense of security and post-operative discomfort, but shows clinical relevant
reduction in some domains
• Some patients have unmet needs after discharge especially regarding management of pain and bowel function
• Fast track pathways in radical prostatectomy are very well implemented in daily clinical practice and ensure early and appropriate
rehabilitation after radical prostatectomy

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