Liu Xiuping, Liu Dongmei, Pan Chunyu, Su Hui
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
J Pers Med. 2022 Dec 21;13(1):11. doi: 10.3390/jpm13010011.
Objectives: Information on the prediction of improved semen parameters following varicocelectomy is scarce and mostly contradictory. Therefore, we developed and validated a nomogram to predict whether abnormal semen parameters in infertile men could improve following microscopic varicocelectomy (MSV). Methods: From January 2018 to December 2021, 460 consecutive patients who underwent MSV were included. Of them, 336 patients as a development cohort at the Xiang Hua institution. As a validation cohort, Hu Nan Center (124 patients) was used. Clinicopathologic patient information was recorded. The likelihood ratio test using Akaike’s information criteria was employed as the stopping rule, and multivariate logistic regression was utilized to create a prediction model with regression coefficients. The effectiveness of this prediction model was evaluated based on its ability of discrimination, calibration, and clinical utility. Results: The initial total progressively motile sperm count (TPMSC) and vein diameter were predictors of this model. The model demonstrated strong discrimination for the validation cohort, with an area under the receiver operating characteristic (AUROC) of 0.925 (p < 0.001), and strong calibration (unreliability test, p = 0.522). The decision curve study proved the model’s clinical applicability. Conclusion: According to our research, the improvement of semen parameters in infertile men following MSV was significantly predicted by greater vein diameter and higher initial TPMSC. This nomogram aids in individualized decision-making on the varicocele preoperative treatment plan and may help to enhance the therapeutic result.
关于精索静脉曲张手术后精液参数改善预测的信息匮乏且大多相互矛盾。因此，我们开发并验证了一种列线图，以预测不育男性异常精液参数在显微镜下精索静脉曲张切除术（MSV）后是否会改善。方法：纳入2018年1月至2021年12月连续接受MSV的460例患者。其中，336例患者作为湘华机构的开发队列。作为验证队列，使用湖南中心（124例患者）。记录患者的临床病理信息。采用基于赤池信息准则的似然比检验作为停止规则，并利用多因素逻辑回归创建具有回归系数的预测模型。基于该预测模型的辨别能力、校准能力和临床实用性对其有效性进行评估。结果：初始总渐进性活动精子计数（TPMSC）和静脉直径是该模型的预测因素。该模型在验证队列中表现出很强的辨别能力，受试者操作特征曲线下面积（AUROC）为0.925（p<0.001），且校准良好（不可靠性检验，p=0.522）。决策曲线研究证明了该模型的临床适用性。结论：根据我们的研究，MSV后不育男性精液参数的改善可通过更大的静脉直径和更高的初始TPMSC显著预测。该列线图有助于精索静脉曲张术前治疗方案的个体化决策，并可能有助于提高治疗效果。
