Factors influencing post-traumatic growth in patients with urinary incontinence following robot-assisted laparoscopic radical prostatectomy: A positive psychology perspective
Abstract
Background: Urinary incontinence (UI) after prostate cancer (PCa) surgery not only causes physiological dysfunction but also induces profound psychological distress. However, current research primarily focuses on pathological mechanisms and negative psychological outcomes, neglecting the potential for positive transformation through post-traumatic growth (PTG). Objective: This study aimed to identify the factors influencing PTG in patients with UI after robot-assisted laparoscopic radical prostatectomy (RARP) from a positive psychology perspective. Methods: We enrolled 215 PCa patients with UI admitted to our hospital between June 2023 and January 2025. At discharge, standardized scales were administered to assess PTG (Post-traumatic Growth Inventory [PTGI]), psychological resilience (Connor-Davidson Resilience Scale [CD-RISC]), gratitude (Gratitude Questionnaire-6 [GQ-6]), and self-disclosure (Distress Disclosure Index [DDI]). Baseline demographic and clinical data, including age, education level, household income, and duration of UI, were collected. Logistic regression analysis was performed to determine the predictors of PTG. Results: The total PTGI score exhibited a significant positive correlation with psychological resilience (p < 0.05). Multivariate logistic regression analysis identified household income per capita, gratitude, self-compassion, and self-disclosure as independent predictors of PTG (p < 0.05). In contrast, the duration of UI, education level, and erectile dysfunction showed no significant association (p > 0.05). Conclusion: Financial strain, limited health literacy, maladaptive cognitive patterns, and insufficient social support are key barriers to PTG in patients with post-RARP UI. Conversely, gratitude and self-compassion promote PTG by fostering life meaning reconstruction and mitigating psychological distress.
Copyright (c) 2025 Shan Qi, Junjun Chen, Qiong Wang, Ruolei Li, Yanan Hu, Yuqing He
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Ning J, Tang X, Shi H, et al. Social support and posttraumatic growth: A meta-analysis. Journal of Affective Disorders. 2023; 320: 117–132. doi: 10.1016/j.jad.2022.09.114
2. Carlsson SV, Vickers AJ. Screening for prostate cancer. Medical Clinics of North America. 2020; 104(6): 1051–1062. doi: 10.1016/j.mcna.2020.08.007
3. Graham LS, Lin JK, Lage DE, et al. Management of prostate cancer in older adults. American Society of Clinical Oncology Educational Book. 2023; 43: e390396. doi: 10.1200/edbk_390396
4. Wang F, Wang C, Xia H, et al. Burden of prostate cancer in China, 1990–2019: Findings from the 2019 global burden of disease study. Frontiers in Endocrinology. 2022; 13: 853623. doi: 10.3389/fendo.2022.853623
5. Li JK, Tang T, Zong H, et al. Intelligent medicine in focus: The 5 stages of evolution in robot-assisted surgery for prostate cancer in the past 20 years and future implications. Military Medical Research. 2024; 11(1): 58. doi: 10.1186/s40779-024-00566-z
6. Wu X, Wong CH, Gandaglia G, et al. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Current Opinion in Urology. 2023; 33(6): 482–487. doi: 10.1097/mou.0000000000001127
7. Chen Y, Hao H, Chen S, et al. Insights into urinary incontinence after robot-assisted radical prostatectomy: Urgent urinary incontinence or stress urinary incontinence. World Journal of Urology. 2023; 41(12): 3635–3642. doi: 10.1007/s00345-023-04584-9
8. Rosiello G, Gandaglia G, Scuderi S, et al. Reducing the risk of postoperative complications after robot-assisted radical prostatectomy in prostate cancer patients: Results of an audit and feedback intervention following the implementation of prospective data collection. European Urology Focus. 2022; 8(2): 431–437. doi: 10.1016/j.euf.2021.03.026
9. Baskin A, Cowan JE, Braun A, et al. Long-term complications and health-related quality of life outcomes after radical prostatectomy with or without subsequent radiation treatment for prostate cancer. Urologic Oncology. 2023; 41(10): 429.e9-429.e14. doi: 10.1016/j.urolonc.2023.06.003
10. Chen L, Huang F, Xu W, et al. Effect of individualized peep on perioperative pulmonary complications in elderly patients with prostate cancer undergoing general anesthesia in trendelenburg position: A single-center retrospective study. Archivos Españoles de Urología. 2023; 76(5): 319–327. doi: 10.56434/j.arch.esp.urol.20237605.37
11. Franco A, Magno S. The breaking point and post-traumatic growth in breast cancer survivors. Cancers. 2023; 15(18): 4441. doi: 10.3390/cancers15184441
12. Karaman IGY, Kacar CY, Dirik G, et al. Posttraumatic stress, posttraumatic growth, and heart rate variability among breast cancer survivors. Nöro Psikiyatri Arşivi. 2025; 62(2): 150–155. doi: 10.29399/npa.28713
13. Li RH, Peng HL, Yeh MH, Lou J. Psychological well-being increment as post-traumatic growth in women with breast cancer: A controlled comparison design using propensity score matching. Healthcare. 2022; 10(8): 1388. doi: 10.3390/healthcare10081388
14. Demirci A, Hamidi N, Uzel T, et al. The 5-factor modified frailty index is effective in treatment decision and the determination of perioperative complications in patients with localized prostate cancer. Supportive Care in Cancer. 2023; 31(10): 603. doi: 10.1007/s00520-023-08078-7
15. Lowrance W, Dreicer R, Jarrard DF, et al. Updates to advanced prostate cancer: AUA/SUO guideline (2023). Journal of Urology. 2023; 209(6): 1082–1090. doi: 10.1097/ju.0000000000003452
16. Tilki D, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. Part ii-2024 update: Treatment of relapsing and metastatic prostate cancer. European Urology. 2024; 86(2): 148–163. doi: 10.1016/j.eururo.2024.03.027
17. Ho SMY, Cheng CT, Shih SM, et al. The chinese version of posttraumatic growth and depreciation inventory-expanded version (ptgdi-x) for cancer survivors. Supportive Care in Cancer. 2022; 30(1): 237–249. doi: 10.1007/s00520-021-06223-8
18. Wang Y, Xu J, Yang S, et al. Exploratory graph analysis on the connor-davidson resilience scale (cd-risc) among older adults in china. Scientific Reports. 2023; 13(1): 19971.
19. Aghababaei N, Akbarilakeh M, Ahmady S, et al. Translation and validation of iranian version of the gratitude at work scale (GAWS). Journal of Religion and Health. 2024; 63(5): 3778–3792. doi: 10.1007/s10943-024-02101-9
20. Datta-Barua I, Hauser J. Clinician self-disclosure in palliative care: Describing a taxonomy and proposing a communication tool. American Journal of Hospice and Palliative Care. 2023; 40(9): 987–993. doi: 10.1177/10499091231154228
21. Lee SY, Park CL, Laflash S. Perceived posttraumatic growth in cardiac patients: A systematic scoping review. Journal of Traumatic Stress. 2022; 35(3): 791–803. doi: 10.1002/jts.22799
22. Yang L, Yang Z, Cheng Y. How fear of COVID-19 promotes posttraumatic growth during COVID-19 epidemic: A moderated mediation model. Psychological Trauma. 2024; 16(4): 543–550. doi: 10.1037/tra0001603
23. Tanyi Z, Mirnics Z, Ferenczi A, et al. Cancer as a source of posttraumatic growth: A brief review. Psychiatria Danubina. 2020; 32(Suppl 4): 401–411.
24. Baseotto MC, Morris PG, Gillespie DC, et al. Post-traumatic growth and value-directed living after acquired brain injury. Neuropsychological Rehabilitation. 2022; 32(1): 84–103. doi: 10.1080/09602011.2020.1798254
25. Manove EE, Poon CYS, Rhodes JE, et al. Changes in psychosocial resources as predictors of posttraumatic growth: A longitudinal study of low-income, female hurricane katrina survivors. Traumatology. 2021; 27(4): 346–353. doi: 10.1037/trm0000318.
26. Hong M, Lv S. The current situation and influencing factors of posttraumatic growth in parents of children with autism:
27. A qualitative study. BMC Psychology. 2025; 13(1): 646. doi: 10.1186/s40359-025-03059-3
28. Lee Y, You M. Trajectories and influencing factors of post-traumatic stress in disaster-affected people according to their income level: A longitudinal study in South Korea. Disaster Medicine and Public Health Preparedness. 2025; 19: e18. doi: 10.1017/dmp.2024.138
29. Confino D, Einav M, Margalit M. Post-traumatic growth: The roles of the sense of entitlement, gratitude and hope. International Journal of Applied Positive Psychology. 2023; 27: 1–13. doi: 10.1007/s41042-023-00102-9
30. Kim K, Lee J, Yoon J. Effects of emotional regulation, resilience, and distress disclosure on post-traumatic growth in nursing students. International Journal of Environmental Research and Public Health. 2023; 20(4): 2782. doi: 10.3390/ijerph20042782
31. Matsui M, Taku K, Tsutsumi R, et al. Role of peer support in posttraumatic growth among adolescent and young adult cancer patients and survivors. Journal of Adolescent and Young Adult Oncology. 2023; 12(4): 503–511.
32. Peng X, Zhao HZ, Yang Y, et al. Post-traumatic growth level and its influencing factors among frontline nurses during the COVID-19 pandemic. Frontiers in Psychiatry. 2021; 12: 632360. doi: 10.3389/fpsyt.2021.632360
33. Benedetti MG, Tarricone I, Monti M, et al. Psychological well-being, self-esteem, quality of life and gender differences as determinants of post-traumatic growth in long-Term Knee Rotationplasty Survivors: A cohort study. Children. 2023; 10(5): 867. doi: 10.3390/children10050867
34. Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer:
35. A systematic review and meta-analysis. Psychooncology. 2018; 27(4): 1100–1109. doi: 10.1002/pon.4577
