老年良性前列腺增生患者术后排尿相关并发症危险因素分析及其预测模型的构建

Risk factors analysis and prediction model construction of postoperative urination-related complications in elderly patients with benign prostatic hyperplasia

目的分析引发老年良性前列腺增生患者术后排尿相关并发症的危险因素,并构建其风险预测模型。方法回顾性分析2021年4月至2023年9月衡阳市第一人民医院127例行经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗的老年良性前列腺增生患者的临床资料,所有样本基于单因素基础上行logistic回归分析,以此构建风险预测模型。结果127例患者中,45例患者发生排尿相关并发症(尿失禁22例,尿潴留15例,排尿困难8例)。单因素及多因素logistic回归分析显示,术前国际前列腺症状评分(International Prostate Symptom Score,IPSS)评分、尿路感染、逼尿肌功能及术后尿管留置时间进入回归模型(P<0.05),均为影响患者术后排尿相关并发症发生的独立危险因素。根据上述多因素logisitc回归分析结果,构建其风险预测模型:P=-2.184+1.357×术前IPSS评分+1.483×尿路感染+1.512×逼尿肌功能+1.596×术后尿管留置时间。采用受试者工作特征曲线验证上述预测模型对患者术后排尿相关并发症的预测价值,结果显示,受试者工作特征曲线下面积为0.852。结论术前IPSS评分高、尿路感染、逼尿肌功能不稳定及术后尿管留置时间长均为导致老年良性前列腺增生患者术后排尿相关并发症发生的重要因素,基于上述因素构建其风险预测模型,对早期筛查术后排尿相关并发症发生高危患者具有一定的临床预测价值。

Objective To analyze the risk factors causing postoperative urination-related complications in elderly patients with benign prostatic hyperplasia,and construct their risk prediction model.Methods The data of127 elderly patients with benign prostate hyperplasia treated by transurethral prostate resection in Hengyang First People's Hospital from April 2021 to September 2023 were analyzed by logistic regression based on univariate basis to build a risk prediction model.Results Of the 127 patients,45 experienced urination-related complications(22 urinary incontinence,15 urinary retention and 8 dysuria).Univariate and multivariate logistic regression analysis showed that the preoperative International Prostate Symptom Score(IPSS)score,urinary tract infection,detrusor function,and postoperative urinary catheter retention time into the regression model(P<0.05)were independent risk factors affecting the occurrence of postoperative urination-related complications in patients.According to the results of the above multivariate logisitc regression analysis,the risk prediction model was constructed:IPSS score before P=-2.184+1.357xpreoperative IPSS score+1.483×urinary tract infection+1.512×detrusor function+1.596×postoperative urinary catheter indrvelling time.The ROC curve was used to verify the predictive value of the above prediction model for postoperative urination-related complications,which showed that the area under the ROC curve was0.852.Conclusions Preoperative IPSS score,urinary tract infection,detrusor function instability and long postoperative urinary catheter indwelling time are important factors leading to postoperative urination related complications in elderly patients with benign prostate hyperplasia.The risk prediction model based on the above factors has certain clinical prediction value for early screening postoperative urination related complications.