Development and validation of a prediction model for bothersome stress urinary incontinence after prolapse surgery: A retrospective cohort study

Objective: To develop and validate a prediction model for bothersome stress urinary incontinence after prolapse surgery and to compare it with an existing clinical prediction model (CUPIDO model). Design: Retrospective cohort study. Setting: Two tertiary hospitals in South Korea. Population: A total of 1142 patients who underwent prolapse surgery with or without a concomitant midurethral sling. Methods: To construct a prediction model, we performed logistic regression using both exhaustive and stepwise variable selection, validating the model both internally and externally. Main Outcome Measures: Bothersome stress urinary incontinence defined as the presence of bothersome symptoms of stress urinary incontinence and/or subsequent continence procedure one year after surgery. Results: Postoperative bothersome stress urinary incontinence occurred in 10% of patients. A model containing six predictors (age, diabetes mellitus, subjective urinary incontinence, prolapse reduction stress test result, type of prolapse surgery, and a concomitant midurethral sling) showed excellent performance for predicting bothersome stress urinary incontinence (area under the curve 0.74, 95% confidence interval 0.62–0.86) and outperformed the CUPIDO model (area under the curve 0.63, 95% confidence interval 0.49–0.76; DeLong’s test P = 0.014). Conclusions: This prediction model might be a useful tool to guide patient decision making regarding a concomitant continence procedure at the time of prolapse surgery. The predictive value of this model needs to be validated further in cohorts with different characteristics. Tweetable Abstract: The proposed prediction model for bothersome stress urinary incontinence after prolapse surgery outperforms an existing model.