Development and validation of a nomogram for predicting early stress urinary incontinence following endoscopic enucleation of the prostate - Report - MDSpire
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Development and validation of a nomogram for predicting early stress urinary incontinence following endoscopic enucleation of the prostate
Nomogram Predicts Early Stress Urinary Incontinence After Endoscopic Prostate Enucleation
Overview
A nomogram was developed and validated to predict early stress urinary incontinence (SUI) following endoscopic enucleation of the prostate (EEP). Key independent predictors identified include older age, higher BMI, longer lower urinary tract symptoms (LUTS) duration, larger prostate volume, and longer surgery time.
Background
Endoscopic enucleation of the prostate (EEP) has become a preferred alternative to traditional transurethral resection of the prostate (TURP) due to improved functional outcomes and reduced complications. However, early postoperative stress urinary incontinence (SUI) remains a concern, occurring more frequently after EEP than TURP. SUI negatively impacts patients' quality of life despite often being transient. While predictive models exist for SUI after radical prostatectomy, no comprehensive nomogram for post-EEP SUI prediction had been reported prior to this study.
Data Highlights
Characteristic
SUI Present (n=78)
SUI Absent (n=248)
P Value
Age ≥ 65 < 70 years
Increased risk (OR 2.48, 95% CI 1.20–5.56)
Reference
0.019
Age ≥ 75 years
Increased risk (OR 4.92, 95% CI 2.32–11.25)
Reference
<0.001
BMI 25–30 kg/m2
Increased risk (OR 1.74, 95% CI 1.01–3.03)
Reference
0.005
BMI ≥ 30 kg/m2
Increased risk (OR 6.50, 95% CI 2.42–18.18)
Reference
<0.001
LUTS duration ≥ 5 years
Increased risk (OR 2.19, 95% CI 1.31–3.70)
Reference
<0.001
Prostate volume ≥ 75 ml
Increased risk (OR 3.61, 95% CI 2.13–6.16)
Reference
<0.001
Surgery time ≥ 100 min
Increased risk (OR 1.93, 95% CI 1.15–3.25)
Reference
0.013
Key Findings
Early SUI occurred in 23.9% of patients at 1-week post-EEP.
Older age (≥65 years), especially ≥75 years, significantly increased early SUI risk.
Higher BMI, particularly ≥30 kg/m2, was strongly associated with early SUI.
Longer duration of LUTS (≥5 years) and larger prostate volume (≥75 ml) independently predicted early SUI.
Longer operation time (≥100 minutes) was also an independent risk factor for early SUI.
A nomogram incorporating these factors demonstrated good predictive performance for early SUI after EEP.
Clinical Implications
This nomogram enables clinicians to identify patients at high risk for early SUI following EEP, facilitating targeted perioperative counseling and timely interventions such as pelvic floor muscle exercises. Awareness of modifiable risk factors like BMI and surgical duration may guide preoperative optimization and surgical planning to minimize SUI incidence. Early identification and management of SUI can improve postoperative quality of life for patients undergoing EEP.
Conclusion
A validated nomogram incorporating age, BMI, LUTS duration, prostate volume, and surgery time effectively predicts early SUI after EEP. This tool supports personalized risk assessment and may improve patient outcomes through early intervention.
References
Song et al. 2024 -- Creation and assessment of a nomogram for forecasting early stress urinary incontinence after endoscopic prostate enucleation
Board-certified urologist Yvonne K. P. Koch, M.D., has joined Baptist Health Urology. She specializes in general urology and male and female voiding dysfunction.
