经尿道前列腺等离子剜除术后尿失禁危险因素分析及风险预测模型构建

Analysis of risk factors and establishment of risk prediction model of urinary incontinence after transurethral plasmakinetic enucleation of prostate

目的探讨经尿道前列腺等离子剜除术后发生尿失禁的相关危险因素,并建立风险预测模型,为临床治疗良性前列腺增生(BPH)及预防尿失禁发生提供临床指导。方法回顾性分析2018年1月至2023年12月本院接受经尿道前列腺等离子剜除术治疗的712例BPH患者的临床资料,分析患者的实验室检查指标及影像学、尿流动力学资料、手术情况及术后随访资料。采用单因素和多因素logistic回归分析术后发生压力性尿失禁(SUI)的影响因素,并进一步建立Nomogram风险预测模型。结果单因素logistic回归分析结果显示,年龄≥75岁、前列腺体积≥90 mL、BMI≥24 kg/m 2、手术时间和导尿管气囊注水量与SUI的发生均有相关性(均P<0.05)。多因素logistic回归分析结果显示,年龄≥75岁、前列腺体积≥90 mL及手术时间较长是术后发生SUI的独立危险因素(均P<0.01)。Nomogram临床风险预测模型结果提示年龄越大、前列腺体积越大、手术时间越长,术后发生SUI的风险越高。结论在选择经尿道前列腺剜除术治疗BPH时,应充分考虑患者年龄及前列腺体积等情况,尽量缩短手术时间以减少术后SUI的发生。

ObjectiveTo investigate the risk factors of urinary incontinence after transurethral plasmakinetic enucleation of prostate through clinical data collection and analysis,and establish a risk prediction model to provide clinical guidance for clinical treatment of benign prostatic hyperplasia(BPH)and prevention of urinary incontinence.MethodsThe clinical data of 712 patients with benign prostatic hyperplasia who underwent transurethral plasma enucleation of prostate from January 2018 to December 2023 were collected retrospectively,including demographic data,laboratory examination and imaging data,urodynamic data,operation and postoperative follow-up data.The influencing factors of postoperative stress urinary incontinence(SUI)were analyzed by univariate and multivariate logistic regression,and a Nomogram risk prediction model was established.ResultsUnivariate logistic regression analysis showed that age≥75 years old,prostate volume≥90 mL,BMI≥24 kg/m 2,operation time and postoperative catheter balloon water injection were correlated with the occurrence of SUI(all P<0.05).Multivariate logistic regression analysis further found that age≥75 years,prostate volume≥90 mL and long operation time were independent risk factors for postoperative urinary incontinence(all P<0.01).The Nomogram clinical risk prediction model indicated that the older the age,the larger the prostate volume,and the longer the operation time,the higher the risk of postoperative SUI.ConclusionsIn the selection of transurethral prostate enucleation for the treatment of BPH,due to full consideration of the patient′s age and prostate volume,the operation time should be shortened as much as possible to reduce the occurrence of postoperative SUI.