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International Urogynecology Journal

, Volume 30, Issue 10, pp 1719–1723 | Cite as

External validation of de novo stress urinary incontinence prediction model after vaginal prolapse surgery

  • Jordi SabadellEmail author
  • Sabina Salicrú
  • Anabel Montero-Armengol
  • Núria Rodriguez-Mias
  • Antonio Gil-Moreno
  • Jose L. Poza
Original Article
  • 228 Downloads

Abstract

Introduction and hypothesis

Stress urinary incontinence (SUI) may appear after the correction of pelvic organ prolapse (POP). The aim of this study was to externally validate a described predictive model for de novo SUI and to assess its clinical performance when used as a diagnostic test.

Methods

This was a retrospective descriptive study on a cohort of consecutive women treated in our institution. The main outcome used to validate the model was the presence of objective or subjective SUI 1 year after surgery. A receiver operating characteristic curve was generated from our population to evaluate the predictive accuracy and to compare it with the original model. A cutoff point of ≥50% was used to evaluate its clinical performance as a diagnostic test.

Results

Of the full cohort, 169 women were suitable for analysis. The rate of de novo SUI was 11.8%. The predictive accuracy of the model in our population was similar to the original [area under the curve (AUC) = 0.69; 95% confidence interval (CI) = 0.58–0.80). However, its performance measures when evaluated as a diagnostic test were low: positive likelihood ratio = 2.71 and negative likelihood ratio = 0.86. Only 15 women presented a positive test result.

Conclusions

External validation of the model found a global predictive accuracy similar to that of the original model. Despite the study being underpowered to give firm conclusions, the test did not show a good clinical performance when applied to our population with low de novo SUI prevalence. A larger sample size is needed to validate the model conclusively.

Keywords

Pelvic organ prolapse Stress urinary incontinence De novo incontinence Predictive model External validation Model performance 

References

  1. 1.
    Maher C, Baessler K, Barber M, et al (2017) Pelvic organ prolapse surgery. In: Abrams P, Cardozo L, Wagg A, Wein A (eds) Incontinence, 6th ed. Tokyo, pp 1859–1992.Google Scholar
  2. 2.
    Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.  https://doi.org/10.1056/NEJMoa1111967.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    van der Ploeg JM, Oude Rengerink K, van der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG. 2015;122:1022–30.  https://doi.org/10.1111/1471-0528.13325.CrossRefPubMedGoogle Scholar
  4. 4.
    Lensen EJM, Withagen MIJ, Kluivers KB, Milani AL, Vierhout ME. Urinary incontinence after surgery for pelvic organ prolapse. Neurourol Urodyn. 2013;32:455–9.  https://doi.org/10.1002/nau.22327.CrossRefPubMedGoogle Scholar
  5. 5.
    Schierlitz L, Dwyer PL, Rosamilia A, et al. Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. Int Urogynecol J. 2014;25:33–40.  https://doi.org/10.1007/s00192-013-2150-7.CrossRefPubMedGoogle Scholar
  6. 6.
    van der Ploeg JM, van der Steen A, Oude Rengerink K, et al. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121:537–47.  https://doi.org/10.1111/1471-0528.12509.CrossRefPubMedGoogle Scholar
  7. 7.
    van der Ploeg JM, van der Steen A, Zwolsman S, et al. Prolapse surgery with or without incontinence procedure; a systematic review and meta-analysis. BJOG. 2018;125:289–97.  https://doi.org/10.1111/1471-0528.14943.CrossRefPubMedGoogle Scholar
  8. 8.
    Matsuoka PK, Pacetta AM, Baracat EC, Haddad JM. Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review. Int Urogynecol J. 2015;26:187–93.  https://doi.org/10.1007/s00192-014-2537-0.CrossRefPubMedGoogle Scholar
  9. 9.
    Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:279–87.  https://doi.org/10.1097/AOG.0000000000000094.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Haylen BT, Ridder D, Freeman RM, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.  https://doi.org/10.1007/s00192-009-0976-9.CrossRefGoogle Scholar
  11. 11.
    Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J. 2006;17:520–4.  https://doi.org/10.1007/s00192-005-0060-z.CrossRefGoogle Scholar
  12. 12.
    Collins GS, Ogundimu EO, Altman DG. Sample size considerations for the external validation of a multivariable prognostic model: a resampling study. Stat Med. 2016;35:214–26.  https://doi.org/10.1002/sim.6787.CrossRefPubMedGoogle Scholar
  13. 13.
    Miranne JM, Gutman RE, Sokol AI, Park AJ, Iglesia CB. Effect of a new risk calculator on patient satisfaction with the decision for concomitant Midurethral sling during prolapse surgery: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2017;23:17–22.  https://doi.org/10.1097/SPV.0000000000000339.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain

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