Wang Hua, Li Shuhao, Wei Song, Cao Sue, Huang Xi, Hu Cheng
Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Transl Androl Urol. 2025 Jan 31;14(1):15-26. doi: 10.21037/tau-24-399. Epub 2025 Jan 21.
Post-biopsy acute urinary retention (AUR) is still a common complication, often leading to extended hospital stays and greater patient discomfort. This study aimed to develop and validate a nomogram for the early identification of AUR after transrectal prostate biopsy (TRPB).
We collected data on patients who underwent TRPB at The Third Affiliated Hospital of Sun Yat-sen University between January 2019 and November 2023, including all characteristics and prostate morphological parameters. A total of 403 patients were screened for eligibility, and after strict screening, 333 patients were included in the study. These patients were randomly divided into a development cohort (n=233) and a validation cohort (n=100) in a 7:3 ratio. Moreover, the International Prostate Symptom Score (IPSS) and quality of life (QoL) before and after biopsy were collected for 66 patients with AUR with varying post-void residual urine volumes (PVR). Additionally, the voiding situation after catheter removal was also documented. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for AUR. The performance of the nomogram was assessed via calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.
The PVR (200-300 mL) group showed significantly lower IPSS and QoL on post-biopsy day 7 compared to the 301-500 mL and >500 mL groups (P<0.05 and P<0.001, respectively). Additionally, the PVR (200-300 mL) group had the highest urinary catheter removal success rate. Univariate and multivariate logistic regression analyses identified 3 clinical factors-hypercholesteremia, prostatic urethral length (PUL), and the prostatic urethral angle (PUA)-that are significantly correlated with the AUR. This nomogram exhibited strong discriminative ability in both the development and validation cohorts, with an area under the curve (AUC) of 0.834 [95% confidence interval (CI): 0.772-0.896] in the development cohort and an AUC of 0.895 (95% CI: 0.831-0.958) in the validation cohort. The Hosmer-Lemeshow test indicated a well-fitted calibration curve (P=0.69). Furthermore, DCA and the CIC suggested favorable clinical utility for the nomogram.
Here, we first determined that patients unable to void with a PVR >200 mL should be considered as having AUR and developed a nomogram to predict its occurrence, facilitating individualized medical treatment after TRPB.
活检后急性尿潴留（AUR）仍是一种常见并发症，常导致住院时间延长和患者不适感增加。本研究旨在开发并验证一种列线图，用于经直肠前列腺活检（TRPB）后早期识别AUR。
我们收集了2019年1月至2023年11月在中山大学附属第三医院接受TRPB的患者数据，包括所有特征和前列腺形态参数。共筛选出403例符合条件的患者，经过严格筛选，333例患者纳入研究。这些患者按7:3的比例随机分为开发队列（n = 233）和验证队列（n = 100）。此外，收集了66例不同残余尿量（PVR）的AUR患者活检前后的国际前列腺症状评分（IPSS）和生活质量（QoL）。另外，还记录了拔除导尿管后的排尿情况。采用单因素和多因素逻辑回归分析确定AUR的独立危险因素。通过校准曲线、Harrell一致性指数（C指数）、决策曲线分析（DCA）和临床影响曲线（CIC）分析评估列线图的性能。
与PVR为301 - 500 mL组和>500 mL组相比，PVR为200 - 300 mL组在活检后第7天的IPSS和QoL显著更低（分别为P<0.05和P<0.001）。此外，PVR为200 - 300 mL组的导尿管拔除成功率最高。单因素和多因素逻辑回归分析确定了3个临床因素——高胆固醇血症、前列腺尿道长度（PUL）和前列腺尿道角（PUA）——与AUR显著相关。该列线图在开发队列和验证队列中均表现出较强的判别能力，开发队列中的曲线下面积（AUC）为0.834 [95%置信区间（CI）：0.772 - 0.896]，验证队列中的AUC为0.895（95% CI：0.
