Influencing factors of stress urinary incontinence in patients with pelvic organ prolapse after pelvic floor reconstruction and construction of nomogram prediction model

doi:10.3877/cma.j.issn.1674-3253.2024.06.012

Abstract

Abstract:

Objective

To explore the influencing factors of stress urinary incontinence （SUI）after transvaginal mesh （TVM） surgery in patients with pelvic organ prolapse （POP） and construct a column chart prediction model.

Methods

A retrospective collection of clinical data was conducted on 180 patients who underwent transvaginal mesh due to POP stage II-IV admitted to the Suzhou High-tech Zone People's Hospital from May 2019 to May 2021. The degree of prolapse was evaluated using the POP-Q staging method of the International Association for Urinary Control. Patients were divided into SUI group（51 cases） and N-SUI group （129 cases） based on whether they had SUI after TVM surgery. Multivariate logistic regression analysis was conducted to identify the influencing factors of SUI after TVM surgery.Introduce the factors that affect postoperative SUI in TVM into R3.6.3 software and RMS package，and construct a column chart model for predicting the risk of postoperative SUI in TVM. Draw a calibration curve，which is the receiver operating characteristic （ROC） curve，to evaluate the model.

Results

Among the 180 POP patients，51 cases （28.33%） developed SUI after TVM surgery，the proportion of vaginal delivery，preoperative urodynamic examination occult SUI （UDS-OSUI），parity ≥2，and preoperative UDS urethral obstruction in the SUI group was significantly higher than that in the N-SUI group，and the proportion of combined anti UI surgery was lower than that in the N-SUI group （P＜0.05）. Multivariate logistic regression analysis showed that combined anti UI surgery was a protective factor for concurrent SUI （P＜0.05），while vaginal delivery，preoperative UDS-OSUI，parity≥2，and preoperative UDS urethral obstruction were independent risk factors for concurrent SUI （P＜0.05）. The column chart model shows that vaginal delivery increases the weight by 74.9 points，preoperative UDS-OSUI increases the weight by 100 points，parity ≥2 increases the weight by 75.1 points，preoperative UDS urethral obstruction increases the weight by 82.5 points，and no combined anti UI surgery increases the weight by 92.2 points. The H-L fitting test shows that，χ²=4.072，P=0.771. The slope of the calibration curve approaches 1. ROC curve was used to evaluate model discrimination，with an area under the curve of 0.875 （95%CI: 0.817-0.919），and sensitivity and specificity of 74.51% and 83.72%，respectively.

Conclusion

Vaginal delivery，preoperative UDSOSUI，parity ≥2，preoperative UDS urethral obstruction，and combined anti UI surgery are all influencing factors of postoperative SUI in TVM. The column chart prediction model constructed in this study has high value in the evaluation of SUI and may be used for personalized prediction of SUI.

Key words: Pelvic organ prolapse, Transvaginal mesh, Stress urinary incontinence, Nomogram prediction model

Qinfang Qu, Fanglian Shu. Influencing factors of stress urinary incontinence in patients with pelvic organ prolapse after pelvic floor reconstruction and construction of nomogram prediction model[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 606-612.

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URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2024.06.012

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2024/V18/I06/606

Figures/Tables 5

因素	SUI组（n=51）	N-SUI组（n=129）	统计值	P值
年龄［岁，（ $\bar{x}$ ±s）］	66±11	65±8	t=0.535	0.593
BMI［kg/m²，（ $\bar{x}$ ±s）］	25.0±3.1	24.8±2.9	t=0.511	0.610
脱垂病程［月，（ $\bar{x}$ ±s）］	20±10	20±8	t＜0.001	＞0.999
孕次［次，（ $\bar{x}$ ±s）］	3.7±1.3	3.6±1.4	t=0.177	0.860
产次［次，（ $\bar{x}$ ±s）］	3.12±1.31	3.06±1.25	t=0.286	0.775
绝经［例（%）］			χ²=0.884	0.347
是	14（27.45）	27（20.93）
否	37（72.55）	102（79.07）
子宫切除［例（%）］			χ²=0.980	0.322
是	4（7.84）	4（3.10）
否	47（92.16）	125（96.90）
糖尿病［例（%）］			χ²=0.819	0.365
是	13（25.49）	25（19.38）
否	38（74.51）	104（80.62）
COPD［例（%）］			χ²=0.705	0.401
是	2（3.92）	1（0.78）
否	49（96.08）	128（99.22）
阴道分娩［例（%）］			χ²=11.081	0.001
是	16（31.37）	14（10.85）
否	35（68.63）	115（89.15）
术前UDS-OSUI［例（%）］			χ²=14.412	＜0.001
是	19（37.25）	16（12.40）
否	32（62.75）	113（87.60）
孕产次≥2［例（%）］			χ²=6.513	0.011
是	36（70.59）	64（49.61）
否	15（29.41）	65（50.39）
POP-Q分期［例（%）］			χ²=0.476	0.788
Ⅱ期	2（3.92）	6（4.65）
Ⅲ期	43（84.31）	112（86.82）
Ⅳ期	6（11.77）	11（8.53）
术后尿残留［ml，（ $\bar{x}$ ±s）］	5.2±1.3	5.2±1.2	t=0.449	0.654
术前UDS-尿道梗阻［例（%）］			χ²=8.081	0.004
是	9（17.65）	6（4.65）
否	42（82.35）	123（95.35）
功能尿道长度［cm，（ $\bar{x}$ ±s）］	2.56±0.76	2.55±0.79	t=0.077	0.938
术前UDS-残余尿量［ml，（ $\bar{x}$ ±s）］	11.2±3.7	11.3±4.2	t=0.164	0.870
逼尿肌稳定［例（%）］			χ²=0.163	0.686
是	41（80.39）	107（82.95）
否	10（19.61）	22（17.05）
平均尿流率［ml/s，（ $\bar{x}$ ±s）］	6.1±2.7	6.3±2.7	t=0.357	0.722
峰值尿流率［ml/s，（ $\bar{x}$ ±s）］	14±4	14±5	t=0.750	0.454
联合抗UI术［例（%）］
是	5（9.80）	63（48.84）	χ²=23.691	＜0.001
否	46（90.20）	66（51.16）
因素	SUI组（n=51）	N-SUI组（n=129）	统计值	P值
重建术式［例（%）］
阴道封闭术	16（31.37）	39（30.23）
阴道网片重建术	18（35.29）	37（28.68）
阴道前壁修补术	8（15.69）	30（23.26）	χ²=1.788	0.775
骶韧带悬吊术/骶骨阴道固定术	5（9.80）	15（11.63）
骶棘韧带固定术	4（7.84）	8（6.20）

因素	SUI组（n=51）	N-SUI组（n=129）	统计值	P值
年龄［岁，（ $\bar{x}$ ±s）］	66±11	65±8	t=0.535	0.593
BMI［kg/m²，（ $\bar{x}$ ±s）］	25.0±3.1	24.8±2.9	t=0.511	0.610
脱垂病程［月，（ $\bar{x}$ ±s）］	20±10	20±8	t＜0.001	＞0.999
孕次［次，（ $\bar{x}$ ±s）］	3.7±1.3	3.6±1.4	t=0.177	0.860
产次［次，（ $\bar{x}$ ±s）］	3.12±1.31	3.06±1.25	t=0.286	0.775
绝经［例（%）］			χ²=0.884	0.347
是	14（27.45）	27（20.93）
否	37（72.55）	102（79.07）
子宫切除［例（%）］			χ²=0.980	0.322
是	4（7.84）	4（3.10）
否	47（92.16）	125（96.90）
糖尿病［例（%）］			χ²=0.819	0.365
是	13（25.49）	25（19.38）
否	38（74.51）	104（80.62）
COPD［例（%）］			χ²=0.705	0.401
是	2（3.92）	1（0.78）
否	49（96.08）	128（99.22）
阴道分娩［例（%）］			χ²=11.081	0.001
是	16（31.37）	14（10.85）
否	35（68.63）	115（89.15）
术前UDS-OSUI［例（%）］			χ²=14.412	＜0.001
是	19（37.25）	16（12.40）
否	32（62.75）	113（87.60）
孕产次≥2［例（%）］			χ²=6.513	0.011
是	36（70.59）	64（49.61）
否	15（29.41）	65（50.39）
POP-Q分期［例（%）］			χ²=0.476	0.788
Ⅱ期	2（3.92）	6（4.65）
Ⅲ期	43（84.31）	112（86.82）
Ⅳ期	6（11.77）	11（8.53）
术后尿残留［ml，（ $\bar{x}$ ±s）］	5.2±1.3	5.2±1.2	t=0.449	0.654
术前UDS-尿道梗阻［例（%）］			χ²=8.081	0.004
是	9（17.65）	6（4.65）
否	42（82.35）	123（95.35）
功能尿道长度［cm，（ $\bar{x}$ ±s）］	2.56±0.76	2.55±0.79	t=0.077	0.938
术前UDS-残余尿量［ml，（ $\bar{x}$ ±s）］	11.2±3.7	11.3±4.2	t=0.164	0.870
逼尿肌稳定［例（%）］			χ²=0.163	0.686
是	41（80.39）	107（82.95）
否	10（19.61）	22（17.05）
平均尿流率［ml/s，（ $\bar{x}$ ±s）］	6.1±2.7	6.3±2.7	t=0.357	0.722
峰值尿流率［ml/s，（ $\bar{x}$ ±s）］	14±4	14±5	t=0.750	0.454
联合抗UI术［例（%）］
是	5（9.80）	63（48.84）	χ²=23.691	＜0.001
否	46（90.20）	66（51.16）
因素	SUI组（n=51）	N-SUI组（n=129）	统计值	P值
重建术式［例（%）］
阴道封闭术	16（31.37）	39（30.23）
阴道网片重建术	18（35.29）	37（28.68）
阴道前壁修补术	8（15.69）	30（23.26）	χ²=1.788	0.775
骶韧带悬吊术/骶骨阴道固定术	5（9.80）	15（11.63）
骶棘韧带固定术	4（7.84）	8（6.20）

因素	赋值	B	S.E	Wals	P值	OR	95%CI
因素	赋值	B	S.E	Wals	P值	OR	下限	上限
阴道分娩	“否”=0，“是”=1	1.100	0.429	6.568	0.010	3.003	1.295	6.963
术前UDS-OSUI	“否”=0，“是”=1	1.471	0.442	11.100	0.001	4.356	1.833	10.351
孕产次≥2	“否”=0，“是”=1	1.342	0.440	9.307	0.002	3.826	1.616	9.060
术前UDS-尿道梗阻	“否”=0，“是”=1	1.213	0.451	7.238	0.007	3.363	1.390	8.139
联合抗UI术	“否”=0，“是”=1	-1.112	0.454	6.002	0.014	0.329	0.135	0.801
常量		-1.595	0.481	10.986	0.001	0.203

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