膜性尿道长度变化与经尿道前列腺汽化电切术后尿失禁发生的关系

Relationship between the length of membranous urethra and urinary incontinence after transurethral vaporization of the prostate

目的探究良性前列腺增生(Benign prostatic hyperplasia,BPH)患者膜性尿道长度(Membranous urethral length,MUL)变化与经尿道前列腺汽化电切术后发生尿失禁的关系。方法选取2020年2月—2023年2月我院收治的413例BPH患者作为研究对象,随机分为训练集(n=328)和验证集(n=85),根据患者术后30 d是否发生尿失禁,将患者分为尿失禁组和预后良好组,比较两组患者临床资料,多因素Logistic分析MUL与术后患者发生尿失禁的关系,筛选尿失禁发生的危险因素,R软件构建预测模型,采用Bootstrap方法对该模型进行内部验证,利用验证集对模型进行外部验证。结果训练集和验证集患者术后30 d发生尿失禁的病例数分别为60例和14例,所占比例分别为18.29%和16.47%,组间差异不显著(P>0.05),术后6个月尿失禁情况逐渐消失。训练集2组患者在临床资料上,各项临床指标均无显著性差异(P>0.05);治疗后,两组患者在手术时间、留置导尿管时间、前列腺体积(Prostatic volume,PV)、膜性尿道长度(Membranous urethral length,MUL)、国际前列腺症状评分-排尿症状(International Prostatic Symptom Score-Voiding,IPSS-V)、最大膀胱容量(Maximum cystometric capacity,MCC)、黄体生成素(Luteinizing hormone,LH)、睾酮(Testosterone,T)指标上的差异具有统计学意义(P<0.05),预后良好组患者治疗后MUL明显大于尿失禁组。Logistic模型回归显示,术前MUL和术后MUL与尿失禁的关联性稳定存在,趋势性检验差异均有统计学意义(P趋势<0.05),限制性立方样条模型显示:患者尿失禁发生风险与年龄不存在非线性关系(P<0.05)。手术时间≥60 min、留置导尿管时间≥7 d、PV≥50 mL、术前MUL<14 mm、术后MUL<13 mm是患者发生尿失禁的危险因子,以此构建的列线图模型,训练集和验证集ROC曲线下面积(AUC)分别为0.879(95%CI:0.864~0.901)和0.872(95%CI:0.828~0.911),灵敏度分别为90.43%和89.85%,特异度分别为88.54%和89.13%,校准曲线显示验证前后模型的预测概率与参考概率拟合度良好,Hosmer-Lemeshow检验结果差异无统计学意义(P>0.05),具有良好的预测精准度,且具有较高的净获益值。结论术前MUL≤14 mm以及术后MUL≤13 mm是患者术后尿失禁的危险因素,较长的MUL可以降低术后并发症风险,加快患者尿控恢复。

Objective To explore the correlation of membranous urethral length(MUL)in benign prostatic hyperplasia(BPH)patients with urinary incontinence after transurethral vaporization of the prostate.Methods Total of 413 patients with BPH admited to our hospital from February 2020 to February 2023 were selected as the research objects,and they were randomly divided into the training set(n=328)and the validation set(n=85).According to whether the patients had urinary incontinence 30 d after surgery,the patients were divided into the urinary incontinence group and the favorable prognosis group,and the clinical data of the two groups were compared.Multivariate Logistic analysis was conducted to analyze the relationship between MUL and the occurrence of urinary incontinence in postoperative patients,and the risk factors of urinary incontinence were screened.R software was used to build a prediction model,and Bootstrap method was used to verify the model internally,and verification set was used to verify the model externally.Results In the training set and the verification set,the number of patients with urinary incontinence 30 d after surgery was 60 and 14,accounting for 18.29%and 16.47%,respectively,with no significant difference between groups(P>0.05),and urinary incontinence gradually disappeared 6 months after surgery.There were no significant dfferences in the clinical data of the patients in the training set(P>0.05).After treatment,there were statistically significant differences in operative time,indwelling catheter time,PV,MUL,IPSS-V score,MCC,LH and T indexes between the two groups(P<O.05).After treatment,MUL in the group with favorable prognosis was significantly higher than that in the urinary incontinence group.Logistic model regression showed that there was a stable association between MUL and urinary incontinence before and after surgery,and the difference in trend test was statistically significant(P<0.05).Restricted cubic spline model showed that there was no non-linear relationship between the risk of urinary incontinence and age(P<0.05).Operation time≥60 min,indurating catheter time≥7 d,PV≥50 mL,preoperative MUL<14 mm and postoperative MUL<13 mm were risk factors for urinary incontinence in patients.The area under ROC curve(AUC)of the training set and validation set were 0.879(95%CI:0.864~0.901)and 0.872(95%Cl:0.828~0.911),the sensitivity was 90.43%and 89.85%,and the specificity was 88.54%and 89.13%,respectively.The calibration curve showed a good fit between the prediction probability and the reference probability of the model before and after verification,and there was no statistical significance between the Hosmer-Lemeshow test results(P>O.05).It had good prediction accuracy and high net benefit value.Conclusion Preoperative MUL≤14 mm and postoperative MUL≤13 mm are risk factors for postoperative urinary incontinence.Longer MUL can reduce the risk of postoperative complications and accelerate the recovery of urinary control in patients.