Identification of risk factors and construction of a predictive model for postoperative new-onset stress urinary incontinence in patients with pelvic organ prolapse: A single-center retrospective study

Yan Yue, Wei Wu, Jianshan Zhou, Liming Wang

Abstract

This study was to identify independent risk factors for new-onset stress urinary incontinence (SUI) after pelvic organ prolapse (POP) surgery and to develop and validate optimized prediction models, thereby providing an evidence-based tool for clinical decision-making. A single-center retrospective cohort study was conducted, including 213 patients who underwent POP surgery. Data on baseline characteristics, preoperative assessments, surgical details, and 12-month postoperative follow-up were collected via the electronic medical record system. Multiple imputation was used to handle missing data, least absolute shrinkage and selection operator (LASSO) regression for feature selection, and both logistic regression and classification and regression tree (CART) decision tree models were developed. LASSO regression identified preoperative POP-Q stage, abnormal urodynamics with prolapse reduction, postmenopausal duration >10 years, and parity as core risk factors. The logistic regression model achieved an internally validated area under curve (AUC) of 0.78 and accuracy of 83.0%, with external validation AUC of 0.75. After calibration, Hosmer-Lemeshow test yielded P=0.65. The CART decision tree model demonstrated an internally validated AUC of 0.84 and accuracy of 87.4%, with external validation AUC of 0.81 and accuracy of 85.2%. Preoperative POP-Q stage and abnormal urodynamics with prolapse reduction are the strongest predictors of new-onset SUI after POP surgery.

Full Text:

PDF

References

Tunn R, Baessler K, Knüpfer S and Hampel C. Urinary incontinence and pelvic organ prolapse in women. Dtsch Ärztebl Int 2023; 120(5): 71-80.

Collins S and Lewicky-Gaupp C. Pelvic organ prolapse. Gastroenterol Clin North Am 2022; 51(1): 177-193.

Raju R and Linder BJ. Evaluation and management of pelvic organ prolapse. Mayo Clin Proc 2021; 96(12): 3122-3129.

Liu H. Toxic medicine used in Traditional Chinese Medicine for cancer treatment: are ion channels involved?. J Trad Chin Med 2022; 42(6): 1019-1022.

Fatton B, de Tayrac R, Letouzey V and Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol 2020; 17(7): 373-390.

Lo TS, Tan YL. Concurrent anti-stress urinary incontinence (SUI) surgery for advanced pelvic organ prolapse (POP) surgery and SUI: an Asian perspective footnote from the Pan-Asia meeting. Int Urogynecol J 2021; 32(6): 1329-1330.

Jin Z, Zhang W, Liu H, Ding A, Lin Y, Wu SX, Lin J. Potential therapeutic application of local anesthetics in cancer treatment. Recent Pat Anticancer Drug Discov 2022; 17(4): 326-342.

Wong JWH and Ramm O. Urinary incontinence and pelvic organ prolapse. Clin Obstet Gynecol 2021; 64(2): 314-320.

Li M, Liu T, Wang B, Qiao P and Wang S. MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse. World J Urol 2024; 42(1): 321(1-7).

Ward A, Farengo-Clark D, McKenna DB, Safonov A, Good M, Le A, Kessler L, Shah PD, Bradbury AR, Domchek SM, Nathanson KL, Powers J and Maxwell KN. Clinical management of TP53 mosaic variants found on germline genetic testing. Cancer Genet 2024; 284-285: 43-47.

Bachar A, Wang X, Herzog K, Sahil S, Cheng AL, Ohene-Agyei JA, Shepherd JP and Sutkin G. Hemoglobin A1c and reoperation after surgery for stress incontinence or prolapse. Urogynecology (Philadelphia) 2023; 30(7): 628-636.

Zhang D, Gao L, Jia Y, Wang S, Wang H, Sun X, Wang J. Construction of progress prediction model of urinary incontinence in elderly women: protocol for a multi-center, prospective cohort study. Int J Environ Res Public Health 2022; 19(2): 734(1-11).

Liang S, Huang S, Andarini E, Wang Y, Li Y and Cai W. Development and internal validation of a risk prediction model for stress urinary incontinence throughout pregnancy: A multicenter retrospective longitudinal study in Indonesia. Neurourol Urody 2024; 43(2): 354-363.

Wang Q, Jiang XX, Que YZ, Wan XY, Lin CQ. Development and validation of a risk prediction model for female stress urinary incontinence in rural fujian, China. Risk Manag Healthc Policy 2024; 17: 1101-1112.

Kieres P, Skorupska K, Mlodawski J, Misiek M, Rokitaⴕ W, Rechberger T. Reliability of The King’s Health Questionnaire and the International Consultation on Incontinence Modular Questionnaire (ICIQ-SF) Short Form in assessing urinary incontinence effects in Polish women. Ginekol Pol, 2021;92(12):850-855.

Nyhus MØ, Salvesen KÅ, Volløyhaug I. Association between pelvic floor muscle trauma and contraction in parous women from a general population. Ultrasound Obstet Gynecol, 2019;53(2):262-268.

RD, Snell KI, Ensor J, Burke DL, Harrell FE Jr, Moons KG, Collins GS. Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes. Stat Med, 2019;38(7):1276-1296.

Kim MJ, Lee Y, Suh DH, Lee S and Jeon MJ. External validation of the de novo stress urinary incontinence prediction model after pelvic organ prolapse surgery in Korean women: a retrospective cohort study. BMC Womens Health 2023; 23(1): 656(1-5).

Liu W and Qian L. Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data. Int Urogynecol J 2022; 33(12): 3491-3497.

Cheng H, Gong F, Shen Y, OuYang P, Ni R and Gao H. A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study. Taiwan J Obstet Gynecol 2022; 61(4): 580-584.

van Doorn T, Reuvers SHM, Roobol MJ, Remmers S, Verbeek JFM, Scheepe JR, Wolterbeek JH, van der Schoot DKE, Nieboer D, ‘t Hoen LA and Blok BFM. Development of a prediction model in female pure or predominant urge urinary incontinence: a retrospective cohort study. Ther Adv Urol 2022; 14: 17562872221090319(1-15)

Refbacks

  • There are currently no refbacks.