良性前列腺增生微创术后尿道狭窄的危险因素分析

Analysis of risk factors for urethral stricture after minimally invasive treatment of benign prostatic hyperplasia

目的基于列线图分析良性前列腺增生(BPH)微创术后尿道狭窄(US)的危险因素。方法选取2019年1月—2022年1月在天水市第二人民医院行微创术的BPH患者162例,术后随访6个月,统计US发生情况,分为US组、无US组。比较两组患者一般资料;采用多因素Logistic逐步回归模型分析BPH微创术后US的危险因素;建立BPH微创术后US的列线图风险模型,并评估其效能及预测价值。结果随访6个月后,BPH行微创术患者US发生率为18.52%(30/162)。US组与无US组患者尿路感染、手术操作不规范、术中行尿道扩张、术后导尿管留置时间>14 d构成比比较,差异均有统计学意义(P<0.05)。多因素Logistic逐步回归分析结果显示,尿路感染[OR=6.521(95%CI:4.568,8.474)]、手术操作不规范[OR=3.789(95%CI:1.254,6.323)]、术中行尿道扩张[OR=2.818(95%CI:1.986,3.650)]、术后导尿管留置时间>14 d[OR=2.683(95%CI:1.365,4.001)]为BPH微创术后US的危险因素(P<0.05)。将上述风险因素作为预测变量,建立列线图预测模型,总分0~45分,对应概率为0.03~0.99,总分越高,BPH微创术后US发生风险越高。绘制Calibration曲线,校正曲线与理想曲线,差异无统计学意义(P>0.05),显示校正曲线与理想曲线是拟合的。采用Bootstrap法内部验证,C-index指数为0.789(95%CI:0.714,0.864),区分度良好;以风险总分为自变量,是否发生US为因变量,受试者工作特征曲线分析结果显示,列线图风险模型预测BPH微创术后US的敏感性为86.42%(95%CI:74.54%,98.30%),特异性为70.37%(95%CI:65.21%,75.53%),曲线下面积为0.729(95%CI:0.653,0.795),该模型预测效能良好。结论尿路感染、手术操作不规范、术中行尿道扩张、术后导尿管留置时间>14 d均为BPH微创术后US的危险因素,列线图风险模型预测效能良好,可为评估BPH微创术后US的发生风险提供可靠的预测方式。

Objective To analyze the risk factors for urethral stricture(US)after minimally invasive treatment of benign prostatic hyperplasia(BPH)based on nomogram.Methods A total of 162 BPH patients who underwent minimally invasive treatment in our hospital from January 2019 to January 2022 were selected,and they were followed up for 6 months after surgery.According to the occurrence of US,the patients were divided into US group and non-US group.The general data of the two groups were compared.The multivariable stepwise Logistic regression model was adopted to analyze the risk factors of US after minimally invasive treatment of BPH.A risk nomogram model for US after minimally invasive treatment of BPH was established,and its efficacy and predictive value were assessed.Results After 6 months of follow-up,the incidence of US in 162 BPH patients who received minimally invasive treatment was 18.52%(30/162).The composition ratios of preoperative urinary tract infection,non-standard surgical operation,intraoperative urethral dilatation,and the duration of postoperative catheter indwelling>14 days were different between the US group and the non-US group(P<0.05).Multivariable stepwise Logistic regression analysis revealed that preoperative urinary tract infection[OR=6.521(95%CI:4.568,8.474)],non-standard surgical operation[OR=3.789(95%CI:1.254,6.323)],intraoperative urethral dilatation[OR=2.818(95%CI:1.986,3.650)],and the duration of postoperative catheter indwelling>14 days[OR=2.683(95%CI:1.365,4.001)]were risk factors for postoperative US(P<0.05).Taking the above risk factors as predictors,a nomogram prediction model was established.The total score ranged from 0 to 45 points,and the corresponding probability range was 0.03 to 0.99.The higher the total score,the higher the risk of US after minimally invasive treatment of BPH.The calibration curve was plotted,and there was no significant difference between the calibration curve and the ideal curve(P>0.05),indicating that the calibration curve was well fitted.The Bootstrap method was used for internal validation,and the C-index was 0.789(95%CI:0.714,0.864),which was suggestive of a good degree of discrimination.With the total score as the independent variable and the occurrence of US as the dependent variable,the receiver operating characteristic(ROC)curve analysis demonstrated that the risk nomogram model exhibited a sensitivity of 86.42%(95%CI:74.54%,98.30%),a specificity of 70.37%(95%CI:65.21%,75.53%),and an area under the ROC curve(AUC)of 0.729(95%CI:0.653,0.795)for predicting US after minimally invasive treatment of BPH,thereby showing excellent predictive performance.Conclusions Preoperative urinary tract infection,non-standard surgical operation,intraoperative urethral dilatation,and duration of postoperative catheter indwelling>14 days are risk factors for postoperative US after minimally invasive treatment of BPH.The risk nomogram model based on these risk factors exhibits good predictive performance,and represents a reliable prediction method for evaluating the risk of US after minimally invasive treatment of BPH.