West China School of Nursing, Sichuan University/Department of Gynecology and Obstetrics Nursing, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
BMJ Open. 2024 Nov 28;14(11):e086706. doi: 10.1136/bmjopen-2024-086706.
To explore influencing factors for postoperative urinary retention (POUR) in cervical cancer patients and construct and validate a POUR prediction model.
A prospective cohort study.
A large tertiary hospital specialised in child and maternal healthcare in Southwest China.
1101 patients undergoing cervical cancer surgery at our hospital were enrolled in the analytic cohort between 1 July 2022 and 31 July 2023. Another 205 patients were enrolled in the external validation cohort between 1 August 2023 and 31 October 2023. Demographics and disease-related information were collected to construct a risk prediction model by logistic regression. Univariate analyses and a multivariate logistic regression analysis were conducted to determine possible influencing factors. The discrimination and accuracy of the model were assessed by the area under the curve (AUC) and the concordance index, respectively.
Univariate analysis identified duration of surgery, intraoperative bleeding, presence of diabetes, hypertension, ureteral adhesion, wound healing classification, preoperative radio/chemotherapy, category of Body Mass Index, history of urinary diseases, history of caesarean section, postoperative urinary infection and use of analgesia pumps as potential influencing factors (p<0.05). Diabetes, wound healing classification, presurgery radio/chemotherapy, postoperative urinary infection, use of analgesia pumps and pain numerical rating score were founded to be significant factors influencing the occurrence of POUR in cervical cancer patients (p<0.05). A POUR prediction model constructed using the factors demonstrated excellent prediction power, with an AUC of 0.897 (95% CI, 0.877 to 0.916, p<0.001). The sensitivity of the model at the optimal threshold was 0.591, with specificity being 0.747. The receiver operating characteristic curve indicated a good performance of the model.
Presence of diabetes mellitus, wound healing classification, presurgery radio/chemotherapy, postoperative urinary infection, use of analgesia pumps and pain numerical rating score are factors influencing occurrence of POUR in cervical cancer patients. The POUR prediction model developed demonstrates good predictive power and is promising for clinical utility.
探讨宫颈癌患者术后尿潴留（POUR）的影响因素，并构建和验证 POUR 预测模型。
前瞻性队列研究。
中国西南地区一家专门从事儿童和孕产妇保健的大型三甲医院。
2022 年 7 月 1 日至 2023 年 7 月 31 日期间，我院收治的 1101 例宫颈癌手术患者纳入分析队列。2023 年 8 月 1 日至 2023 年 10 月 31 日期间，另 205 例患者纳入外部验证队列。收集患者的人口统计学和疾病相关信息，通过逻辑回归构建风险预测模型。进行单因素分析和多因素 logistic 回归分析，确定可能的影响因素。通过曲线下面积（AUC）和一致性指数分别评估模型的区分度和准确性。
单因素分析发现手术时间、术中出血量、糖尿病、高血压、输尿管粘连、伤口愈合分类、术前放化疗、体重指数类别、尿路疾病史、剖宫产史、术后尿路感染和使用镇痛泵与 POUR 的发生有关（p<0.05）。糖尿病、伤口愈合分类、术前放化疗、术后尿路感染、使用镇痛泵和疼痛数字评分是影响宫颈癌患者 POUR 发生的显著因素（p<0.05）。使用这些因素构建的 POUR 预测模型具有优异的预测能力，AUC 为 0.897（95%CI，0.877 至 0.916，p<0.001）。模型在最优阈值下的灵敏度为 0.591，特异性为 0.747。受试者工作特征曲线表明模型具有良好的性能。
糖尿病、伤口愈合分类、术前放化疗、术后尿路感染、使用镇痛泵和疼痛数字评分是影响宫颈癌患者 POUR 发生的因素。开发的 POUR 预测模型具有良好的预测能力，有望在临床应用中发挥作用。
