Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
World J Urol. 2013 Oct;31(5):1045-50. doi: 10.1007/s00345-013-1027-1. Epub 2013 Jan 17.
To identify clinical predictors of bladder outlet obstruction (BOO) in men with the first episode of spontaneous acute urinary retention (AUR), in order to facilitate patient selection for early de-obstructive prostate surgery.
A multichannel urodynamic investigation was performed in 156 consecutive men ≥ 50 years five days following AUR. Clinical routine parameters were evaluated for their ability to predict BOO, which was defined as a BOO-index (BOOI) >40. Univariable and multivariable logistic regression models were fitted. A nomogram was constructed from significant variables of a reduced multivariable model. Discrimination and calibration of the nomogram were assessed.
The mean age of the 156 men was 71.6 years, and the mean drained volume was 953 mL. Seventy-two men (46.2 %) had severe AUR-associated pain. On urodynamic evaluation, 79 (50.6 %) were obstructed (BOOI > 40). In multivariable regression analysis, age (p = 0.014) drained volume (p = 0.044) and pain intensity (p < 0.001) were independently associated with BOO. These variables formed the basis of the nomogram, which predicted BOO with a bootstrap-corrected accuracy of 78.2 %. The positive predictive value, sensitivity, and specificity of a 70 % nomogram cutoff was 83, 51, and 90 %, respectively. Decision-curve analysis demonstrated a net benefit with use of the nomogram.
The routine clinical parameters age, drained volume, and pain intensity are independent predictors of BOO in men with AUR. According to our model, patients with a nomogram predicted BOO probability of >70 % might be candidates for early surgery. External validation of the nomogram is advocated.
确定首次自发性急性尿潴留（AUR）男性患者膀胱出口梗阻（BOO）的临床预测因子，以便为早期去梗阻性前列腺手术的患者选择提供便利。
对 156 例≥50 岁的 AUR 后 5 天的连续男性患者进行多通道尿动力学检查。评估临床常规参数预测 BOO 的能力， BOO 指数（BOOI）>40 定义为 BOO。进行单变量和多变量逻辑回归模型拟合。从简化多变量模型的显著变量构建列线图。评估列线图的区分度和校准度。
156 名男性的平均年龄为 71.6 岁，平均排空量为 953ml。72 名男性（46.2%）存在严重的与 AUR 相关的疼痛。在尿动力学评估中，79 名男性（50.6%）存在梗阻（BOOI>40）。多变量回归分析显示，年龄（p=0.014）、排空量（p=0.044）和疼痛强度（p<0.001）与 BOO 独立相关。这些变量构成了列线图的基础，该列线图的 bootstrap 校正准确性为 78.2%。70%列线图截断值的阳性预测值、敏感度和特异度分别为 83%、51%和 90%。决策曲线分析表明，使用列线图具有净获益。
年龄、排空量和疼痛强度等常规临床参数是 AUR 男性 BOO 的独立预测因子。根据我们的模型，预测 BOO 概率>70%的患者可能是早期手术的候选者。提倡对列线图进行外部验证。
