{"title":"Risk Factor Analysis and Prediction Model Establishment for Urinary Incontinence after Laparoscopic Radical Prostatectomy.","authors":"Ziyang Qiang, Baolin Zhang, Minggang Wang, Shuang Chen","doi":"10.29271/jcpsp.2025.10.1301","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors and to develop a predictive model for urinary incontinence (UI) after laparoscopic radical prostatectomy (LRP).</p><p><strong>Study design: </strong>Observational study. Place and Duration of the Study: Department of Urology, Qinghai University Affiliated Hospital, Xining, China, from June 2019 to June 2024.</p><p><strong>Methodology: </strong>The study analysed 210 prostate cancer patients who underwent LRP at a single tertiary centre. Propensity score matching method was utilised to compare patients with urinary incontinence (UI group, n = 34) to those with urinary continence (Control group, n = 176). Predictors included age, body mass index (BMI), membranous urethral length (MUL), prostate volume, and bladder neck preservation (BNP) status. Multivariable logistic regression was applied to identify independent risk factors, followed by nomogram development and bootstrap validation (1,000 iterations).</p><p><strong>Results: </strong>Significant intergroup differences were observed in MUL [(12.21 ± 2.57) mm vs. (14.97 ± 2.80) mm, p <0.001], prostate volume [(47.41 ± 4.97) ml vs. (37.28 ± 5.27) ml, p <0.001], and BNP status (23.53% vs. 73.86%, p <0.001). Multivariate analysis identified advanced age (OR = 1.714, 95% CI 1.322-2.221), prostate volume ≥50ml (OR = 1.105, 95% CI 1.038-1.177), MUL ≤12mm (OR = 0.430, 95% CI 0.278-0.664), and non-preservation of bladder neck (OR = 6.637, 95% CI 1.496-29.452) as independent UI risk factors. The nomogram demonstrated excellent discrimination, with C-indices of 0.988 (95% CI: 0.977-0.999) in the training set and 0.923 (95% CI: 0.885-0.961) in the validation set. For the combined cohort, the overall area under the curve (AUC) was 0.974 (p <0.001).</p><p><strong>Conclusion: </strong>This model integrates anatomical and surgical factors to predict post-LRP UI risk, demonstrating potential for preoperative risk stratification. However, external validation is required before clinical implementation.</p><p><strong>Key words: </strong>Urinary incontinence, Prostatectomy, Prostate cancer, Nomogram, Risk factors.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 10","pages":"1301-1307"},"PeriodicalIF":0.8000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.29271/jcpsp.2025.10.1301","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To identify risk factors and to develop a predictive model for urinary incontinence (UI) after laparoscopic radical prostatectomy (LRP).
Study design: Observational study. Place and Duration of the Study: Department of Urology, Qinghai University Affiliated Hospital, Xining, China, from June 2019 to June 2024.
Methodology: The study analysed 210 prostate cancer patients who underwent LRP at a single tertiary centre. Propensity score matching method was utilised to compare patients with urinary incontinence (UI group, n = 34) to those with urinary continence (Control group, n = 176). Predictors included age, body mass index (BMI), membranous urethral length (MUL), prostate volume, and bladder neck preservation (BNP) status. Multivariable logistic regression was applied to identify independent risk factors, followed by nomogram development and bootstrap validation (1,000 iterations).
Results: Significant intergroup differences were observed in MUL [(12.21 ± 2.57) mm vs. (14.97 ± 2.80) mm, p <0.001], prostate volume [(47.41 ± 4.97) ml vs. (37.28 ± 5.27) ml, p <0.001], and BNP status (23.53% vs. 73.86%, p <0.001). Multivariate analysis identified advanced age (OR = 1.714, 95% CI 1.322-2.221), prostate volume ≥50ml (OR = 1.105, 95% CI 1.038-1.177), MUL ≤12mm (OR = 0.430, 95% CI 0.278-0.664), and non-preservation of bladder neck (OR = 6.637, 95% CI 1.496-29.452) as independent UI risk factors. The nomogram demonstrated excellent discrimination, with C-indices of 0.988 (95% CI: 0.977-0.999) in the training set and 0.923 (95% CI: 0.885-0.961) in the validation set. For the combined cohort, the overall area under the curve (AUC) was 0.974 (p <0.001).
Conclusion: This model integrates anatomical and surgical factors to predict post-LRP UI risk, demonstrating potential for preoperative risk stratification. However, external validation is required before clinical implementation.
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