Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
Neurourol Urodyn. 2019 Apr;38(4):1086-1092. doi: 10.1002/nau.23958. Epub 2019 Mar 7.
To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test.
Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO-1, n = 134) and without (CUPIDO-2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability.
Three hundred fifty-six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<-1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2-4.6) in the extended model, which increased the optimism-corrected area under the receiver-operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI.
A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.
建立阴道前壁膨出修补术后压力性尿失禁（POSUI）的预测模型，并评估术前压力测试的价值。
对 2 项临床试验进行二次分析，这些试验将女性随机分为行或不行中尿道吊带术（MUS）的脱垂修补组。这两项试验包括伴有（CUPIDO-1，n=134）和不伴有（CUPIDO-2，n=225）共存压力性尿失禁的女性。POSUI 定义为术后 1 年手术相关或治疗相关的压力性尿失禁且需要治疗，或术后 1 年存在压力性尿失禁症状。采用逻辑回归分析建立参考模型，并扩展了术前压力测试。压力测试在脱垂复位和未复位的情况下进行。对于缺失值，采用 20 次插补，并采用 bootstrap 重采样进行内部验证。
共纳入 356 例女性。17%（n=61）的女性发生 POSUI。参考模型包括年龄（<55 岁）、盆腔器官脱垂定量系统的点 Ba（<-1）、阴道分娩次数（≤3）、主观尿失禁和 MUS。在扩展模型中，压力测试的比值比为 2.4（95%置信区间[CI]，1.2-4.6），使校正后的接收者操作特征曲线下面积从 0.74 增加至 0.76。在 POSUI 风险为 10%至 30%的女性中，压力测试具有更高的价值，压力测试显著改变了 POSUI 风险。在超过 50%的女性中，压力测试对预测 POSUI 没有额外价值。
对于阴道前壁膨出修补术后发生压力性尿失禁风险低的女性，术前压力测试没有价值。
