Establishment and validation of nomogram for postpartum stress urinary incontinence / 中华泌尿外科杂志

ABSTRACT

Objective:To analyze the predictive factors of postpartum SUI, and establish and validate nomogram model.Methods:A total of 272 patient from Affiliated Jinhua Hospital, Zhejiang University School of Medicine were reviewed, and the general clinical data and ultrasound parameters were analyzed. The median age (range) was 32 (28-38) years. Vaginal delivery was recorded in 191(70.0%), while cesarean section was performed in 81(30.0%) cases. The average body mass index (BMI) was (23.0±2.9) kg/m 2. The median bladder neck mobility was 2.5cm and rate of bladder neck funnel was 25%. Patients were divided into two groups Group SUI(n=98) and Group NSUI (without SUI, n=174). The independent predicting SUI were analyzed by univariate and multivariate logistic regression analysis. Two predictive models were constructed with the important general clinical data and ultrasound parameters, then receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive power of two models. At last, the nomogram was established for the better model. Results:The results of multivariate analysis showed that age( OR=1.08, P=0.011), delivery method( OR=9.26, P<0.01), body mass index( OR=1.15, P=0.023), bladder neck distance ( OR=1.73, P=0.047) and bladder neck funneling( OR=18.44, P<0.01) were independent predictors for SUI. Two predictive models were used with independent predictors of SUI. The area under the receiver operating characteristic(ROC)curve of validation group was 0.88. The area under the ROC curve of general clinic factors was 0.77. The difference between the two model and other indicators was statistically significant( P<0.001). The nomogram model was well calibrated, with the mean absolute error of 1.9%. Conclusions:Age, delivery method, BMI, bladder neck mobility and bladder neck funneling were independent predictors for SUI. The nomogram model for predicting SUI has a good statistical significance.