个体化预测经尿道前列腺剜除术后压力性尿失禁发生风险的列线图模型构建

Construction of an individual nomogram model for predicting the risk of stress urinary incontinence after transurethral enucleation of the prostate

目的探讨经尿道前列腺剜除术(TUEP)术后压力性尿失禁(SUI)发生的影响因素,并构建个体化预测SUI发生的列线图模型。方法选取2019年3月至2022年6月沧州市人民医院收治的557例行TUEP的良性前列腺增生(BPH)患者作为研究对象,术后开展6个月随访。根据术后是否发生SUI分成SUI组和非SUI组。对两组收集资料的差异开展分析,将差异具有统计学意义的因素纳入Logistic回归分析,最终筛查出影响TUEP术后SUI发生的因素,并利用R软件中RMS包构建列线图模型。绘制受试者工作特征(ROC)曲线,根据曲线下面积(AUC)评价模型预测效果,并行H-L拟合优度检验。结果557例BPH患者TUEP术后发生SUI 51例(9.16%);SUI组年龄≥75岁患者比例、合并糖尿病患者比例、前列腺体积、手术时长、术中剜除组织重量与非SUI组比较,差异具有统计学意义(P<0.05);Logistic回归分析结果显示,BPH患者TUEP术后发生SUI的危险因素包括年龄≥75岁、伴有糖尿病、前列腺体积大、手术耗时长(P<0.05);将这4项因素引入R软件构建列线图模型,结果显示,AUC为0.834(95%CI:0.756~0.912),拟合优度H-L检验χ^(2)=7.108,P=0.527。结论基于年龄≥75岁、伴有糖尿病、前列腺体积大、手术耗时长4项预测变量构建的列线图模型可有效预测TUEP术后SUI的发生风险。

Objective To investigate the influencing factors of stress urinary incontinence(SUI)after transurethral enucleation of the prostate(TUEP),and to construct an individual nomogram model to predict the occurrence of SUI.Methods A total of 557 patients with benign prostatic hyperplasia(BPH)who underwent TUEP in Cangzhou People′s Hospital from March 2019 to June 2022 were selected as study objects,and were followed up for 6 months after operation.The patients were grouped into SUI group and non-SUI group according to whether SUI occurred or not.The differences in the collected data between the two groups were analyzed,and the factors with statistical significance were included in the Logistic regression analysis.Finally,the factors affecting the occurrence of SUI after TUEP were screened out,and the nomogram model was constructed using RMS package in R software.The area under the curve(AUC)of receiver operating characteristic(ROC)was applied to evaluate the prediction effect of the model,and the H-L goodness of fit test was performed.Results SUI occurred in 51(9.16%)of 557 BPH patients after TUEP.There were statistically significant differences in proportion of patients aged≥75 years,proportion of patients with diabetes,prostate volume,duration of operation,weight of enucleated tissue during operation in SUI group compared with non-SUI group(P<0.05).Logistic regression analysis showed that the risk factors for SUI in BPH patients after TUEP included age≥75 years,suffered from diabetes,large prostate volume,and long operation duration(P<0.05).Four factors were introduced into R software to construct the nomogram model,and the results showed that AUC was 0.834(95%CI:0.756-0.912),and the goodness of fit H-L testχ^(2)=7.108,P=0.527.Conclusions The nomogram model constructed with age≥75 years,suffered from diabetes,large prostate volume and long operation duration can well predict the risk of SUI occurence after TUEP.