External validation of de novo stress urinary incontinence prediction model after vaginal prolapse surgery
- 228 Downloads
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.
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.
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.
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.
KeywordsPelvic organ prolapse Stress urinary incontinence De novo incontinence Predictive model External validation Model performance
- 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
- 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
- 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
- 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