Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Clinical Epidemiology and Medical Technology Assessment (KEMTA) and Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, and Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, the Netherlands.
Obstet Gynecol. 2016 Feb;127(2):341-7. doi: 10.1097/AOG.0000000000001272.
To develop a prediction model that estimates the risk of anatomical cystocele recurrence after surgery.
The databases of two multicenter prospective cohort studies were combined, and we performed a retrospective secondary analysis of these data. Women undergoing an anterior colporrhaphy without mesh materials and without previous pelvic organ prolapse (POP) surgery filled in a questionnaire, underwent translabial three-dimensional ultrasonography, and underwent staging of POP preoperatively and postoperatively. We developed a prediction model using multivariable logistic regression and internally validated it using standard bootstrapping techniques. The performance of the prediction model was assessed by computing indices of overall performance, discriminative ability, calibration, and its clinical utility by computing test characteristics.
Of 287 included women, 149 (51.9%) had anatomical cystocele recurrence. Factors included in the prediction model were assisted delivery, preoperative cystocele stage, number of compartments involved, major levator ani muscle defects, and levator hiatal area during Valsalva. Potential predictors that were excluded after backward elimination because of high P values were age, body mass index, number of vaginal deliveries, and family history of POP. The shrinkage factor resulting from the bootstrap procedure was 0.91. After correction for optimism, Nagelkerke's R and the Brier score were 0.15 and 0.22, respectively. This indicates satisfactory model fit. The area under the receiver operating characteristic curve of the prediction model was 71.6% (95% confidence interval 65.7-77.5). After correction for optimism, the area under the receiver operating characteristic curve was 69.7%.
This prediction model, including history of assisted delivery, preoperative stage, number of compartments, levator defects, and levator hiatus, estimates the risk of anatomical cystocele recurrence.
开发一种预测模型，以估计手术后解剖性膀胱膨出复发的风险。
合并了两项多中心前瞻性队列研究的数据库，并对这些数据进行了回顾性二次分析。接受无网片材料的前阴道壁修补术且无先前盆腔器官脱垂（POP）手术的女性填写了一份问卷，接受经阴道三维超声检查，并在术前和术后进行了 POP 分期。我们使用多变量逻辑回归建立了预测模型，并使用标准的自举技术对其进行内部验证。通过计算总性能、判别能力、校准和计算测试特征的临床实用性来评估预测模型的性能。
在 287 名纳入的女性中，有 149 名（51.9%）发生了解剖性膀胱膨出复发。预测模型中包含的因素包括辅助分娩、术前膀胱膨出分期、受累隔室数量、主要肛提肌缺陷以及 Valsalva 时的肛提肌裂孔面积。由于 P 值较高而被排除在向后消除之外的潜在预测因子包括年龄、体重指数、阴道分娩次数和 POP 家族史。自举程序产生的收缩因子为 0.91。经校正后，Nagelkerke 的 R 和 Brier 评分分别为 0.15 和 0.22，这表明模型拟合良好。预测模型的受试者工作特征曲线下面积为 71.6%（95%置信区间为 65.7-77.5）。经校正后，受试者工作特征曲线下面积为 69.7%。
该预测模型包括辅助分娩史、术前分期、隔室数量、肛提肌缺陷和肛提肌裂孔，可估计解剖性膀胱膨出复发的风险。
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