Prostate cancer is among the most prevalent malignancies in men worldwide. Treatment modalities include radical prostatectomy, radiotherapy, hormone therapy, and chemotherapy (4). While surgical removal effectively eliminates the primary tumor and prolongs survival, postoperative urinary incontinence remains a major complication (4). This functional disorder not only affects physical health but also imposes psychological distress and reduced quality of life (20, 27). Studies indicate that 20–30% of patients experience persistent UI even one year after surgery, with some enduring symptoms for years (3, 23).

Pelvic floor muscle training (PFMT) is a key method for improving UI by restoring urethral sphincter and pelvic floor muscle function (26). However, traditional care models primarily rely on face-to-face medical guidance and outpatient follow-ups, which often fail to deliver continuous and personalized support (17). Frequent follow-up visits also pose financial and logistical burdens, especially for patients in rural or economically disadvantaged areas (6). Furthermore, low compliance and reduced motivation limit the effectiveness of such care. Smoking has been reported to impair pelvic floor muscle function and delay postoperative recovery by reducing tissue oxygenation and microvascular perfusion, thereby increasing the risk of urinary incontinence. Consequently, evaluating compliance among smokers is clinically relevant, as adherence to rehabilitation programs may have a greater impact on outcomes in this subgroup.

With the growing adoption of internet and mobile technologies, WeChat-based health management has emerged as a feasible alternative. As one of the most widely used social platforms in China, WeChat (developed by Tencent Holdings Ltd., Shenzhen, China) offers instant communication and supports health education through subscription accounts, chat groups, and mini-programs. It is a commercially operated but free-to-use application that allows healthcare providers to communicate with patients without additional costs. In this study, nurses utilized existing WeChat functions to deliver postoperative instructions, PFMT videos, and personalized rehabilitation plans while monitoring patient responses in real time. This model transcends the limitations of traditional care, efficiently reaching patients with UI and enhancing engagement and adherence.

Although WeChat-based nursing has been increasingly applied in chronic disease management (25) and postoperative rehabilitation, systematic research specifically targeting UI after prostatectomy is still limited. Most existing studies report preliminary results or small-scale trials without long-term evaluations (12, 13, 29). Furthermore, few studies have established data-driven, dynamically adaptive WeChat models that quantify nursing engagement and link behavioral indicators to recovery outcomes. This study therefore retrospectively analyzes the application of WeChat education in prostate cancer patients with postoperative UI, assess its long-term effects, identify key factors influencing UI improvement, and provide scientific evidence for optimizing WeChat-based personalized care. The results may accelerate recovery of urinary continence and guide modern nursing practice in the digital era.

The results of this retrospective cohort study underscore the clinical value and feasibility of a WeChat-based personalized rehabilitation nursing model in managing UI after radical prostatectomy. This model demonstrated superior outcomes compared to traditional nursing approaches in terms of symptom improvement, quality of life, patient engagement, and recovery time. Beyond statistical significance, these improvements were clinically meaningful: the mean reduction of 2.7 points in ICIQ-SF and increase of 0.06 in EQ-5D exceeded the minimal clinically important difference (MCID) thresholds (≥2 and ≥0.05, respectively), confirming practical benefits for patients. These findings not only reflect the growing potential of digital health interventions in urological care but also contribute to the evolving paradigm of precision nursing in the postoperative period. In terms of feasibility, the program required no additional equipment or paid applications. The intervention was implemented using existing WeChat functions and nursing manpower, with nurses dedicating fixed daily time slots to review feedback and adjust care plans, which proved sustainable within routine workloads. As a preliminary single-center study, our findings provide early but valuable evidence supporting the feasibility of digital personalized rehabilitation nursing, which warrants validation in larger multicenter randomized controlled trials.

One of the most striking observations was the significantly greater reduction in 24-hour urine leakage and ICIQ-SF scores in the WeChat group, with a concurrent rise in continence recovery rate and quality of life. These improvements can be attributed to several synergistic elements embedded in the digital intervention. First, the integration of daily PFMT videos, individualized rehabilitation plans, and real-time Q&A sessions likely promoted behavioral reinforcement and neuromuscular adaptation (7, 19). Second, the instant feedback mechanism allowed for dynamic adjustments based on patient status, preventing the stagnation or improper execution often seen in traditional outpatient settings (28).

Compliance emerged as a pivotal factor influencing clinical outcomes, supported by both descriptive and multivariate analyses. Patients in the WeChat group demonstrated a 24% higher completion rate and more frequent weekly feedback, reinforcing the notion that active engagement is crucial to sustained functional improvement. These results echo previous findings in chronic disease management where mobile health tools improved adherence and health outcomes (17, 19). Importantly, WeChat’s high accessibility and familiarity among Chinese patients likely contributed to the low technical barrier and strong participation, especially among elderly populations who may otherwise struggle with complex health apps (22).

Interestingly, the benefits of the WeChat model extended beyond physical recovery. Substantial gains were noted in the EQ-5D and SF-36 physical and mental domains, suggesting improvements in both functional capacity and psychological well-being. Postoperative UI is known to induce emotional distress, embarrassment, and social withdrawal (16, 20). The structured guidance and constant reassurance provided through the digital platform likely alleviated anxiety and restored a sense of control, particularly in vulnerable groups such as smokers or those undergoing lymph node dissection (11). These findings underscore the psychosocial dimension of continence rehabilitation and the capacity of digital nursing to provide holistic care.

Among clinical predictors, bilateral nerve-sparing (NVB) surgery was significantly associated with better outcomes, consistent with literature indicating that preservation of neurovascular bundles enhances sphincter integrity and promotes earlier recovery of continence (15). However, surgical approach (robotic vs laparoscopic) and lymph node dissection did not significantly influence continence improvement, suggesting that functional outcomes depend more on individualized postoperative care than on technical variations alone (1, 5, 18). These insights may guide urologists and nurses in tailoring rehabilitation strategies based on intraoperative decisions and patient-specific profiles.

Adjunctive therapies, including medications or supportive interventions, were modest yet statistically significant contributors to UI recovery (9, 24). These likely assist in tissue regeneration or neuromuscular recovery, complementing the behavioral components of PFMT. Further research could explore the optimal combination and timing of such therapies within a digital care framework.

Another noteworthy finding is the accelerated rehabilitation speed in the WeChat group. Patients regained significant continence approximately three weeks earlier than those in the traditional care group, with 78% showing marked improvement within 3 months. Early recovery not only enhances quality of life but may also reduce downstream medical costs and psychological burden, offering public health benefits (2, 21).

The present study is a single-center retrospective cohort analysis, which limits the level of evidence and causal inference. Randomization and blinding were not feasible due to the real-world design; however, baseline matching was applied to mitigate selection bias. Future prospective multicenter randomized controlled trials are warranted to validate and extend these findings. Despite these strengths, several limitations must be acknowledged. The retrospective, single-center design introduces selection bias and limits generalizability. Patients who opted into the WeChat program may have been more health-literate or motivated, potentially skewing compliance and outcomes. Although baseline characteristics were well balanced, unmeasured confounders such as education level or prior digital literacy could influence results. Another limitation is that the sample size was determined by the available cases rather than a pre-study power calculation, which may affect generalizability. However, post-hoc analysis suggested sufficient power for the primary outcomes, supporting the reliability of the main findings. Another limitation is that the retrospective dataset lacked information on education, digital literacy, and family support, which may influence patients’ engagement with digital interventions. Future prospective studies should include these variables to further refine model accuracy. Moreover, the follow-up period, while adequate for assessing short- to mid-term effects, may not capture late recurrences of UI or long-term sustainability of digital engagement. Lastly, satisfaction scores, while favorable, were self-reported and may be subject to response bias. Future studies should aim to validate these findings through multicenter, randomized controlled trials with larger sample sizes and stratified analysis. Incorporating wearable devices or AI-assisted feedback into the WeChat platform could further enhance precision and automation. Additionally, expanding the scope of digital nursing to include other complications such as erectile dysfunction, bowel symptoms, or psychosocial distress could offer a more comprehensive postoperative care ecosystem.

In contrast to earlier descriptive studies, our model integrates quantitative feedback loops and individualized algorithmic adjustments, offering a refined, evidence-based approach to digital rehabilitation nursing. A WeChat-based personalized nursing model significantly improves urinary continence and quality of life after prostatectomy. Key contributors include patient compliance and NVB preservation, with adjunctive therapy offering additional benefits. Compared to traditional care, this model enables more efficient and precise nursing, accelerating recovery and setting a new direction for postoperative UI management and future nursing innovation.