良性前列腺增生等离子前列腺剜除术后尿失禁的Nomogram预测模型构建及临床指导价值

Nomogram prediction model construction and clinical guidance value of urinary incontinence in benign prostatic hyperplasia after plasma prostatectomy

目的:分析良性前列腺增生(BPH)患者等离子前列腺剜除术(PKEP)后尿失禁(UI)Nomogram预测模型构建及临床指导价值。方法:回顾性分析临床资料,选择2021年12月至2023年4月于我院收治的BPH患者250例为观察对象,根据术后UI情况分为UI组(n=68)、no-UI组(n=182),比较两组患者一般资料及临床资料,采用多因素Logistic回归分析BPH患者术后出现UI的影响因素;采用R版3.5.2中的“rms”软件包绘制BPH患者术后出现UI风险的Nomogram预测模型,通过受试者工作特征(ROC)曲线评估所建立模型的诊断效率。结果:UI组患者年龄≥65岁、糖尿病、术前UI占比明显高于no-UI组(P<0.05)。UI组患者术前膜性尿道长度(MUL)水平明显低于no-UI组,膀胱功能失代偿占比、术前前列腺体积、手术时间明显高于no-UI组(P<0.05)。多因素Logistic回归分析显示,患者年龄≥65岁、糖尿病、术前UI、膀胱功能失代偿、术前前列腺体积、手术时间为BPH患者术后出现UI的危险因素,MUL为BPH患者术后出现UI的保护因素(P<0.05)。构建BPH患者术后UI的Nomogram预测模型,ROC曲线分析显示Nomogram预测模型预测BPH患者术后出现UI的曲线下面积(AUC)为0.826(95%CI:0.798~0.934)(P<0.05)。结论:年龄≥65岁、糖尿病、术前UI、膀胱功能失代偿、术前前列腺体积、手术时间与BPH患者术后出现UI存在密切相关,术前MUL为BPH患者术后出现UI的保护因素,基于以上因子构建Nomogram预测模型在预测BPH患者术后出现UI方面具有一定价值,可帮助预测患者术后情况并及时调整治疗方案。

Objective:To analyze the construction and clinical guiding value of nomogram prediction model for urinary incontinence(UI)after plasma kinetic enucleation of the prostate(PKEP)in patients with benign prostatic hyperplasia(BPH).Methods:The clinical data of 250 BPH patients admitted to our hospital from December 2021 to April 2023 were retrospectively analyzed.According to the postoperative UI,they were divided into UI group(n=68)and no-UI group(n=182).The general and clinical data of the two groups were compared,and the influencing factors of postoperative UI in patients with BPH were analyzed by multivariate Logistic regression.Using the"rms"software package in R version 3.5.2,the Nomogram prediction model of UI risk in patients with BPH after operation was drawn,and the diagnostic efficiency of the model was evaluated by the receiver's operating characteristics(ROC)curve.Results:The proportion of patients with age≥65 years old,diabetes and preoperative UI in UI group was significantly higher than that in no-UI group(P<0.05).The preoperative membranous urethra(MUL)level of patients in UI group was significantly lower than that in no-UI group,and the proportion of bladder dysfunction decompensation,preoperative prostate volume and operation time were significantly higher than those in no-UI group(P<0.05).Multivariate Logistic regression analysis showed that patients'age≥65 years,diabetes,preoperative UI,bladder dysfunction decompensation,preoperative prostate volume and operation time were the risk factors for postoperative UI in patients with BPH,and the preoperative length of membranous urethra(MUL)was the protective factor for postoperative UI in patients with BPH(P<0.05).The Nomogram prediction model of postoperative UI of patients with BPH was established.The ROC curve analysis showed that the AUC of Nomogram prediction model for predicting postoperative UI of patients with BPH was 0.826(95%CI 0.798-0.934)(P<0.05).Conclusion:Age≥65 years old,diabetes,preoperative UI,bladder dysfunction decompensation,preoperative prostate volume and operation time are closely related to postoperative UI in patients with BPH.MUL before operation is a protective factor for postoperative UI in patients with BPH.Based on the above factors,it is of certain value to construct Nomogram prediction model in predicting postoperative UI in patients with BPH,which can help predict postoperative conditions of patients and adjust treatment plans in time.