He Hailong, Li Qing, Xu Tao, Zhang Xiaowei
Department of Urology, Peking University People' s Hospital; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Dec 18;56(4):646-655. doi: 10.19723/j.issn.1671-167X.2024.04.017.
To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief.
A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023. This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic spermatic cord pain. All the patients underwent microsurgical procedures: varicocele-related pain was treated with microsurgical varicocelectomy, and idiopathic pain was treated with microsurgical denervation of the spermatic cord. The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50% six months post-surgery compared with pre-surgery levels. Baseline data were preliminarily screened for clinical indicators using tests and univariate analysis. Clinical predictor variables [age, duration of pain, diameter of varicocele, patient health questionnaire-9 (PHQ-9) score, generalized anxiety disorder-7 (GAD-7) score] were selected using Lasso regression. A clinical prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram. The model's internal validation was performed using the bootstrap method. Its predictive power and clinical utility were evaluated through the concor-dance index, the area under the receiver operating characteristic curve, and calibration plots.
Post-microscopic varicocele ligation, 156 patients (73.58%) experienced significant pain relief, as did 94 patients (83.93%) following microscopic denervation. Independent predictors for postoperative outcomes included age, PHQ-9 score, GAD-7 score, chronic pain duration, and varicocele diameter, differing slightly between varicocele-related and idiopathic pain groups. The models demonstrated excellent predictive ability, with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups, respectively, and high concordance indices.
The postoperative efficacy prediction model based on age, pain duration, PHQ-9 score, GAD-7 score, and varicocele diameter has good predictive ability and clinical applicability, and can be used in clinical practice.
探讨影响显微精索手术疗效的相关因素，并建立术后疼痛缓解的预测模型。
回顾性分析2015年10月至2023年4月期间就诊于北京大学人民医院泌尿外科的324例精索疼痛患者的临床资料。该队列包括212例与精索静脉曲张相关的精索疼痛患者和112例特发性精索疼痛患者。所有患者均接受显微手术：与精索静脉曲张相关的疼痛采用显微精索静脉结扎术治疗，特发性疼痛采用显微精索去神经术治疗。根据术后6个月疼痛较术前水平是否降低超过50%，将患者分为有效组和无效组。使用检验和单因素分析对基线数据进行临床指标的初步筛选。使用套索回归选择临床预测变量[年龄、疼痛持续时间、精索静脉曲张直径、患者健康问卷-9（PHQ-9）评分、广泛性焦虑障碍-7（GAD-7）评分]。使用逻辑回归构建显微精索手术后有效疼痛缓解的临床预测模型，并以列线图表示。采用自抽样法对模型进行内部验证。通过一致性指数、受试者操作特征曲线下面积和校准图评估其预测能力和临床实用性。
显微精索静脉结扎术后，156例患者（73.58%）疼痛明显缓解，显微去神经术后94例患者（83.93%）疼痛明显缓解。术后结果的独立预测因素包括年龄、PHQ-9评分、GAD-7评分、慢性疼痛持续时间和精索静脉曲张直径，在精索静脉曲张相关组和特发性疼痛组之间略有差异。模型显示出优异的预测能力，精索静脉曲张组和特发性组的曲线下面积分别为0.909和0.913，一致性指数较高。
基于年龄、疼痛持续时间、PHQ-9评分、GAD-7评分和精索静脉曲张直径的术后疗效预测模型具有良好的预测能力和临床适用性，可用于临床实践。
