Relationship between the length of membranous urethra and urinary incontinence after transurethral vaporization of the prostate.

Objective To explore the correlation of membranous urethral length (MUL) in benign prostatic hyperplasia (BPH) patients with urinary incontinence after transurethral vaporization of the prostate. Methods Total of 413 patients with BPH admitted to our hospital from February 2020 to February 2023 were selected as the research objects, and they were randomly divided into the training set (n =328) and the validation set (n = 85). According to whether the patients had urinary incontinence 30 d after surgery, the patients were divided into the urinary incontinence group and the favorable prognosis group, and the clinical data of the two groups were compared. Multivariate Logistic analysis was conducted to analyze the relationship between MUL and the occurrence of urinary incontinence in postoperative patients, and the risk factors of urinary incontinence were screened. R software was used to build a prediction model, and Bootstrap method was used to verify the model internally, and verification set was used to verify the model externally. Results In the training set and the verification set, the number of patients with urinary incontinence 30 d after surgery was 60 and 14, accounting for 18.29% and 16.47%, respectively, with no significant difference between groups (P>0.05), and urinary incontinence gradually disappeared 6 months after surgery. There were no significant differences in the clinical data of the patients in the training set (P >0.05). After treatment, there were statistically significant differences in operative time, indwelling catheter time, PV, MUL, IPSS-V score, MCC, LH and T indexes between the two groups (P<0.05). After treatment, MUL in the group with favorable prognosis was significantly higher than that in the urinary incontinence group. Logistic model regression showed that there was a stable association between MUL and urinary incontinence before and after surgery, and the difference in trend test was statistically significant (P <0.05). Restricted cubic spline model showed that there was no non-linear relationship between the risk of urinary incontinence and age (P<0. 05). Operation time ≥60 min, indurating catheter time 5=7 d, PV ≥50 mL, preoperative MUL <14 mm and postoperative MUL <13 mm were risk factors for urinary incontinence in patients. The area under ROC curve ( AUC) of the training set and validation set were 0.879 (95% CI- 0.864 ~ 0.901) and 0.872 (95% CI-.0.828 -0.911), the sensitivity was 90.43% and 89.85%, and the specificity was 88.54% and 89.13%, respectively. The calibration curve showed a good fit between the prediction probability and the reference probability of the model before and after verification, and there was no statistical significance between the Hosmer-Lemeshow test results (P > 0.05). It had good prediction accuracy and high net benefit value. Conclusion Preoperative MUL≤14 mm and postoperative MUL≤ 13 mm are risk factors for postoperative urinary incontinence. Longer MUL can reduce the risk of postoperative complications and accelerate the recovery of urinary control in patients. [ABSTRACT FROM AUTHOR]