Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test

Abstract

Objective To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test. Patients and methods Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO‐1, n = 134) and without (CUPIDO‐2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability. Results Three hundred fifty‐six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<−1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2‐4.6) in the extended model, which increased the optimism‐corrected area under the receiver‐operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI. Conclusion A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.

Development and validation of a prediction model for bothersome stress urinary incontinence after prolapse surgery: A retrospective cohort study

“…Diabetes mellitus was included in our model as a predictor but not in the CUPIDO model. This discrepancy might arise from differences in the prevalence of diabetes mellitus between the two study’s participants; 18% of patients in our cohort had diabetes mellitus compared with only 5% among CUPIDO participants 7 . Preoperative POPQ point Ba was not included in our model as a predictor.…”

“…This discrepancy might arise from differences in the prevalence of diabetes mellitus between the two study's participants; 18% of patients in our cohort had diabetes mellitus compared with only 5% among CUPIDO participants. 7 Preoperative POPQ point Ba was not included in our model as a predictor. However, stage I anterior vaginal wall prolapse (Ba <−1) was identified as an increased risk in the CUPIDO model.…”

“…developed another prediction model applicable to all women undergoing vaginal prolapse surgery irrespective of the presence of preoperative SUI symptoms using the dataset from the CUPIDO (Concomitant surgery and Urodynamic investigation in genital Prolapse and stress Incontinence. A Diagnostic study including Outcome evaluation) trials (CUPIDO model) 7 . However, this model cannot be directly applied to women undergoing abdominal prolapse surgery, and its prediction accuracy has not been externally validated.…”

“…A Diagnostic study including Outcome evaluation) trials (CUPIDO model). 7 However, this model cannot be directly applied to women undergoing abdominal prolapse surgery, and its prediction accuracy has not been externally validated.…”

Particle Swarm Algorithm-Based Analysis of Pelvic Dynamic MRI Images in Female Stress Urinary Incontinence

“…Studies have reported that the incidence of pelvic bladder and uterine prolapse in SUI patients accounted for about 25% [ 15 ]. After surgery, pelvic bladder and uterine prolapse accounted for 15% [ 16 ]. In this study, pelvic floor dynamic MRI images showed that the incidence of pelvic bladder and uterine prolapse in experimental patients with SUI was greatly superior to controls ( P < 0.05).…”