Development of a Prediction Model in Female Pure or Predominant Urge Urinary Incontinence: a Retrospective Cohort Study

Overview

Journal Ther Adv Urol

Publisher Sage Publications

Date 2022 Apr 25

PMID 35464652

Authors

Tess van Doorn

Sarah H M Reuvers

Monique J Roobol

Sebastiaan Remmers

Jan F M Verbeek

Jeroen R Scheepe

Josien H Wolterbeek

Deric K E van der Schoot

Daan Nieboer

Lisette A t Hoen

Bertil F M Blok

Affiliations

Soon will be listed here.

Abstract

Background: Urinary incontinence is a prevalent form of pelvic floor dysfunction, with a non-negligible impact on a patient's quality of life. There are several treatment options, varying from conservative to invasive. The aim of this study is to predict treatment outcomes of pure or predominant urge urinary incontinence (UUI) in women to support shared decision-making and manage patient expectations.

Methods: Data on patient characteristics, disease history, and investigations of 512 consecutive women treated for UUI in three hospitals in the Netherlands were retrospectively collected. The predicted outcome was the short-term subjective continence outcome, defined as patient-reported continence 3 months after treatment categorized as cure (no urinary leakage), improvement (any degree of improvement of urinary leakage), and failure (no improvement or worsening of urinary leakage). Multivariable ordinal regression with backward stepwise selection was performed to analyze association between outcome and patient's characteristics. Interactions between patient characteristics and treatment were added to estimate individual treatment benefit. Discriminative ability was assessed with the ordinal c-statistic.

Results: Conservative treatment was applied in 12% of the patients, pharmacological in 62%, and invasive in 26%. Subjective continence outcome was cure, improvement, and failure in 20%, 49%, and 31%, respectively. Number of incontinence episodes per day, voiding frequency during the day, subjective quantity of UI, coexistence of stress urinary incontinence (SUI), night incontinence, and bladder capacity and the interactions between these variables were included in the model. After internal validation, the ordinal c-statistic was 0.699.

Conclusions: Six variables were of value to predict pure or predominant UUI treatment outcome in women. Further development into a comprehensive set of models for the use in various pelvic floor disorders and treatments is recommended to optimize individualized care. This model requires external validation before implementation in clinical practice.

Citing Articles

Machine learning in female urinary incontinence: A scoping review.

Wang Q, Wang X, Jiang X, Lin C Digit Health. 2024; 10:20552076241281450.

PMID: 39381822 PMC: 11459541. DOI: 10.1177/20552076241281450.

References

Roobol M, Steyerberg E, Kranse R, Wolters T, van den Bergh R, Bangma C . A risk-based strategy improves prostate-specific antigen-driven detection of prostate cancer. Eur Urol. 2009; 57(1):79-85. DOI: 10.1016/j.eururo.2009.08.025. View

Lucas M, Bosch R, Burkhard F, Cruz F, Madden T, Nambiar A . EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2012; 62(6):1130-42. DOI: 10.1016/j.eururo.2012.08.047. View

Darekar A, Carlsson M, Quinn S, Ntanios F, Mangan E, Arumi D . Development of a predictive model for urgency urinary incontinence. Contemp Clin Trials. 2016; 51:44-49. DOI: 10.1016/j.cct.2016.09.005. View

Abrams P, Smith A, Cotterill N . The impact of urinary incontinence on health-related quality of life (HRQoL) in a real-world population of women aged 45-60 years: results from a survey in France, Germany, the UK and the USA. BJU Int. 2014; 115(1):143-52. DOI: 10.1111/bju.12852. View

Sung V, Hampton B . Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009; 36(3):421-43. DOI: 10.1016/j.ogc.2009.08.002. View

Van Calster B, Van Belle V, Vergouwe Y, Steyerberg E . Discrimination ability of prediction models for ordinal outcomes: relationships between existing measures and a new measure. Biom J. 2012; 54(5):674-85. DOI: 10.1002/bimj.201200026. View

Hsiao S, Lin H, Kuo H . Factors Associated with Therapeutic Efficacy of Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Syndrome. PLoS One. 2016; 11(1):e0147137. PMC: 4732812. DOI: 10.1371/journal.pone.0147137. View

Marcelissen T, Leong R, Nieman F, van Lankveld J, van Kerrebroeck P, De Wachter S . Psychological and psychiatric factors as predictors for success in sacral neuromodulation treatment. BJU Int. 2011; 108(11):1834-8. DOI: 10.1111/j.1464-410X.2011.10205.x. View

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U . The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003; 61(1):37-49. DOI: 10.1016/s0090-4295(02)02243-4. View

10.

Bleeker S, Moll H, Steyerberg E, Donders A, Derksen-Lubsen G, Grobbee D . External validation is necessary in prediction research: a clinical example. J Clin Epidemiol. 2003; 56(9):826-32. DOI: 10.1016/s0895-4356(03)00207-5. View

11.

Heinze G, Wallisch C, Dunkler D . Variable selection - A review and recommendations for the practicing statistician. Biom J. 2018; 60(3):431-449. PMC: 5969114. DOI: 10.1002/bimj.201700067. View

12.

Herschorn S, Kaplan S, Sun F, Ntanios F . Do patient characteristics predict responsiveness to treatment of overactive bladder with antimuscarinic agents?. Urology. 2014; 83(5):1023-9. DOI: 10.1016/j.urology.2013.12.027. View

13.

Khan Z, Whittal C, Mansol S, Osborne L, Reed P, Emery S . Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstet Gynaecol. 2013; 33(7):710-4. DOI: 10.3109/01443615.2013.813913. View

14.

Dylewski D, Jamison M, Borawski K, Sherman N, Amundsen C, Webster G . A statistical comparison of pad numbers versus pad weights in the quantification of urinary incontinence. Neurourol Urodyn. 2006; 26(1):3-7. DOI: 10.1002/nau.20352. View

15.

Yazdany T, Bhatia N, Nguyen J . Determining outcomes, adverse events, and predictors of success after sacral neuromodulation for lower urinary disorders in women. Int Urogynecol J. 2011; 22(12):1549-54. DOI: 10.1007/s00192-011-1512-2. View

16.

Rachaneni S, Latthe P . Effectiveness of BTX-A and neuromodulation in treating OAB with or without detrusor overactivity: a systematic review. Int Urogynecol J. 2017; 28(6):805-816. DOI: 10.1007/s00192-016-3225-z. View

17.

van Klaveren D, Vergouwe Y, Farooq V, Serruys P, Steyerberg E . Estimates of absolute treatment benefit for individual patients required careful modeling of statistical interactions. J Clin Epidemiol. 2015; 68(11):1366-74. PMC: 5569577. DOI: 10.1016/j.jclinepi.2015.02.012. View

18.

Lucas M, Bosch R, Burkhard F, Cruz F, Madden T, Nambiar A . EAU guidelines on surgical treatment of urinary incontinence. Eur Urol. 2012; 62(6):1118-29. DOI: 10.1016/j.eururo.2012.09.023. View

19.

Steyerberg E, Roobol M, Kattan M, van der Kwast T, de Koning H, Schroder F . Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol. 2006; 177(1):107-12. DOI: 10.1016/j.juro.2006.08.068. View

20.

Steyerberg E, Uno H, Ioannidis J, Van Calster B . Poor performance of clinical prediction models: the harm of commonly applied methods. J Clin Epidemiol. 2017; 98:133-143. DOI: 10.1016/j.jclinepi.2017.11.013. View