Aim <p>The present study was conducted with the objective ascertaining the clinical implication of microRNA-133a-3p (miR-133a-3p) for urinary incontinence (UI) and rehabilitation effects in prostate cancer after radical prostatectomy.</p> Methods <p>The measurements of miR-133a-3p in urethral tissue samples from prostate cancer patients after radical prostatectomy were carried out via quantitative real-time polymerase chain reaction (qRT-PCR) detection. Receiver operation characteristic (ROC) curve and logistic regression analysis were employed for evaluating the predictive significance of miR-133a-3p for the early UI of prostate cancer patients with radical prostatectomy. Bioinformatics tools were employed for mining the miR-133a-3p possible genes.</p> Results <p>An obvious reduction of miR-133a-3p was detected in patients with UI compared with those with urinary continence (UC) (<i>P</i> &lt; 0.001), demonstrating a high diagnostic capacity for patients with UI. Moreover, miR-133a-3p could be an independent predictive index for the early UI in patients with prostate cancer after radical prostatectomy (<i>P</i> &lt; 0.001). Additionally, urine miR-133a-3p was notably increased in the UI patients after rehabilitation (<i>P</i> &lt; 0.001). MiR-133a-3p largely concentered on the muscle-related diseases pathways using bioinformatics tools.</p> Conclusion <p>MiR-133a-3p was a promising indicator for predicting early UI in patients with prostate cancer after radical prostatectomy.</p> Clinical trial number <p>Not applicable.</p>