钬激光前列腺剜除术后暂时性尿失禁临床风险预测模型的建立与验证

Development and validation of a nomogram for predicting transient urinary incontinence following holmium laser enucleation of the prostate

目的 探讨钬激光前列腺剜除(HoLEP)术后暂时性尿失禁的相关危险因素,并建立术后尿失禁风险预测模型。方法 回顾分析2020年6月至2021年5月在本院接受HoLEP治疗的BPH患者的病历资料,所有的患者均进行了至少6个月的随访。采用多因素逐步回归法筛选术后暂时性尿失禁独立危险因素,并建立术后尿失禁临床预测模型。C指数与校准曲线分别用于评价模型的区分度与校准度。结果 共有140名符合条件的患者被纳入分析。多因素逐步回归分析显示:年龄≥70岁(OR=7.56,95%CI:2.21~31.61,P<0.01)、手术耗时≥100min(OR=12.70,95%CI:3.68~55.51,P<0.001)以及未使用膀胱颈保留技术(OR=44.79,95%CI:7.43~894,P<0.001)是Ho LEP术后暂时性尿失禁的独立危险因素。经内部验证,模型的C指数为0.92(95%CI:0.87~0.97),预测曲线紧贴理想曲线。结论 本研究建立的列线图模型对HoLEP术后暂时性尿失禁具有较高的预测价值,可用于识别高危患者并提供及时的干预,提高患者术后满意度。

Objective To identify a set of predictive factors to develop and validate risk prediction models for transient urinary incontinence following holmium laser enucleation of the prostate(HoLEP). Methods From June 2020 to May 2021, a retrospective review was performed on the medical records of BPH patients who underwent HoLEP at our institution. All the patients were followed up for at least six months. Multivariable step-wise regression analyses were used to screen for prognostic risk factors of urinary incontinence. The concordance index(C-index), calibration plots were employed to evaluate the accuracy and discriminatory ability of the model. Results A total of 140 patients were eligible and included in the analysis. Stepwise regression analysis indicated that age ≥ 70 years(OR=7.56,95%CI:2.21~31.61,P<0.01), operation time≥100 min(OR=12.70,95%CI:3.68~55.51,P<0.001) and the absence of bladder neck preserving technique(OR=44.79,95%CI:7.43-894,P<0.001) were significant predictors of UI. The C-index of the model was 0.92(95%CI:0.87~0.97) in the internal validation cohorts and calibration curves were close to 45° line. Conclusion The nomograms are of high efficacy in predicting transient urinary continence following HoLEP, which will be valuable in guiding postoper-ative interventions and increasing their satisfaction.