Vesale Elie, Roman Horace, Abo Carole, Benoit Louise, Tuech Jean-Jacques, Darai Emile, Bendifallah Sofiane
Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 4 rue de la Chine, 75020, Paris, France.
Clinique Tivoli-Ducos, Bordeaux, France.
Int Urogynecol J. 2021 May;32(5):1205-1212. doi: 10.1007/s00192-020-04428-9. Epub 2020 Jul 11.
The aim was to develop a nomogram based on clinical and surgical factors to predict the likelihood of voiding dysfunction after surgery for deep endometriosis.
This was a retrospective study of 789 patients (training set) who underwent surgery for deep endometriosis with colorectal involvement from January 2005 through December 2017 at Tenon University Hospital. A multivariate logistic regression analysis of selected risk factors was performed to construct a nomogram to predict postoperative voiding dysfunction. The nomogram was externally validated in 333 patients (validation set) from Rouen University Hospital.
Postoperative voiding dysfunction occurred in 23% of the patients (180/789) in the training set. Age, colorectal involvement/management, colpectomy and parametrectomy were the main factors associated with an increased risk of voiding dysfunction and were included in the nomogram. The predictive model had an internal concordance index of 0.79 (95% CI: 0.77-0.81) after the 200 repetitions of bootstrap sample corrections and showed good calibration. The ROC area related to the nomogram for external validation was 0.74 (95% CI: 0.72-0.76).
The nomogram we present here, based on four clinical and imaging characteristics, could be useful in predicting postoperative voiding dysfunction for women undergoing surgery for deep endometriosis. Patients could thus be better informed about this postoperative risk and the surgical strategy adapted according to individual risk. The accuracy of the tool was validated externally but additional validation is required.
目的是基于临床和手术因素开发一种列线图，以预测深部子宫内膜异位症手术后排尿功能障碍的可能性。
这是一项对2005年1月至2017年12月在特农大学医院接受深部子宫内膜异位症合并结直肠受累手术的789例患者（训练集）进行的回顾性研究。对选定的风险因素进行多因素逻辑回归分析，以构建预测术后排尿功能障碍的列线图。该列线图在鲁昂大学医院的333例患者（验证集）中进行了外部验证。
训练集中23%的患者（180/789）出现术后排尿功能障碍。年龄、结直肠受累/处理、阴道直肠隔切除术和子宫骶骨韧带切除术是与排尿功能障碍风险增加相关的主要因素，并被纳入列线图。经过200次自抽样校正重复后，预测模型的内部一致性指数为0.79（95%CI：0.77-0.81），并显示出良好的校准。用于外部验证的列线图的ROC曲线下面积为0.74（95%CI：0.72-0.76）。
我们在此展示的基于四种临床和影像学特征的列线图，可能有助于预测接受深部子宫内膜异位症手术的女性术后排尿功能障碍。因此，患者可以更好地了解这种术后风险，并根据个体风险调整手术策略。该工具的准确性已在外部得到验证，但仍需要进一步验证。
