Archivos espanoles de urologia · 2026
Influencing Factors of Urinary Continence Recovery and Construction of a Nomogram Prediction Model After Radical Prostatectomy.
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Qian Kang, Lu Wenwen, Wu Guolin, Gu Jialin
Аннотация
BACKGROUND: Screening clinical factors related to poor urinary control 3 months after radical prostatectomy and constructing a risk prediction model for early postoperative urinary control dysfunction.
METHODS: Retrospective inclusion of clinical data from 300 patients undergoing radical prostatectomy, divided into a modeling cohort (n = 210) and a randomized split internal validation cohort (n = 90) in a 7:3 ratio. Extract preoperative demographic, oncology, imaging, and rehabilitation related variables; Using Least Absolute Shrinkage and Selection Operator Regression (LASSO) to screen for factors related to early postoperative urinary control in prostate cancer patients undergoing radical prostatectomy, the statistically significant variables selected by LASSO were included in a multivariate logistic regression analysis to further explore the independent influencing factors of early postoperative urinary control. A nomogram was built, and its discrimination, calibration and clinical net benefit were evaluated via receiver operating characteristic (ROC) analysis, 1000-bootstrap calibration curves and decision curve analysis (DCA), followed by internal validation.
RESULTS: Preoperative baselines were comparable between cohorts (p > 0.05). Univariate analysis shows that there are eight variables with differences. LASSO regression screening yielded five variables: age, body mass index (BMI), previous transurethral resection of the prostate (TURP), prostate volume, and regular pelvic floor muscle training. Multivariate logistic regression analysis showed that older age, higher BMI, history of TURP, and larger prostate volume were all associated with a higher risk of urinary incontinence; There is a correlation between regular pelvic floor muscle training and a reduced risk of urinary incontinence (p < 0.05). The nomogram achieved good discrimination in the modeling set [area under the curve (AUC) = 0.849, 95% confidence interval (CI) 0.7904-0.9076], with bootstrap calibration showing consistent predicted and actual risks. DCA confirmed superior net benefit over "Treat all" and "Treat none" within the 0-0.60 threshold range. Internal validation yielded an AUC of 0.750 (95% CI 0.633-0.868), with acceptable calibration and steady net benefit despite slightly lower discriminative ability.
CONCLUSIONS: The postoperative early risk stratification nomogram constructed in this study has acceptable discrimination and calibration, and can only be used as a preliminary screening tool to evaluate the risk of poor urinary control recovery 3 months after radical prostatectomy. It can provide auxiliary reference for postoperative rehabilitation decision-making.
METHODS: Retrospective inclusion of clinical data from 300 patients undergoing radical prostatectomy, divided into a modeling cohort (n = 210) and a randomized split internal validation cohort (n = 90) in a 7:3 ratio. Extract preoperative demographic, oncology, imaging, and rehabilitation related variables; Using Least Absolute Shrinkage and Selection Operator Regression (LASSO) to screen for factors related to early postoperative urinary control in prostate cancer patients undergoing radical prostatectomy, the statistically significant variables selected by LASSO were included in a multivariate logistic regression analysis to further explore the independent influencing factors of early postoperative urinary control. A nomogram was built, and its discrimination, calibration and clinical net benefit were evaluated via receiver operating characteristic (ROC) analysis, 1000-bootstrap calibration curves and decision curve analysis (DCA), followed by internal validation.
RESULTS: Preoperative baselines were comparable between cohorts (p > 0.05). Univariate analysis shows that there are eight variables with differences. LASSO regression screening yielded five variables: age, body mass index (BMI), previous transurethral resection of the prostate (TURP), prostate volume, and regular pelvic floor muscle training. Multivariate logistic regression analysis showed that older age, higher BMI, history of TURP, and larger prostate volume were all associated with a higher risk of urinary incontinence; There is a correlation between regular pelvic floor muscle training and a reduced risk of urinary incontinence (p < 0.05). The nomogram achieved good discrimination in the modeling set [area under the curve (AUC) = 0.849, 95% confidence interval (CI) 0.7904-0.9076], with bootstrap calibration showing consistent predicted and actual risks. DCA confirmed superior net benefit over "Treat all" and "Treat none" within the 0-0.60 threshold range. Internal validation yielded an AUC of 0.750 (95% CI 0.633-0.868), with acceptable calibration and steady net benefit despite slightly lower discriminative ability.
CONCLUSIONS: The postoperative early risk stratification nomogram constructed in this study has acceptable discrimination and calibration, and can only be used as a preliminary screening tool to evaluate the risk of poor urinary control recovery 3 months after radical prostatectomy. It can provide auxiliary reference for postoperative rehabilitation decision-making.