Nomogram for predicting urinary retention after radical hysterectomy for cervical cancer with comparative analysis of surgical methods

Abstract

Objective: To identify risk factors for urinary retention after radical hysterectomy for cervical cancer (CC) and establish a nomogram model to facilitate individual treatment decisions.

Methodology: We retrospectively analyzed records of 438 patients with CC undergoing radical hysterectomy between December 2011 to December 2018 at Fujian Maternity and Child Health Hospital. We compared short-term outcomes between patients in the abdominal operation group (196 cases) and the laparoscopic group (242 cases). We identified independent risk factors for urinary retention using a multivariate logistic regression. We established a nomogram and assessed its performance using receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses.

Results: The mean age of patients in the abdominal group was lower than in the laparoscopic group. The operation times and dissected lymph node numbers were higher in the laparoscopic group (P < 0.05), whereas the postoperative hospital stay and volume of blood loss were lower (P < 0.001). The incidence of urinary retention in the laparoscopic group (53.7%) was significantly higher than in the abdominal group (38.2%; P = 0.014). Multivariate logistic regression results identified surgical approach, operation time, lympho-vascular invasion, and age as independent risk factors for postoperative urinary retention (P < 0.05). The urinary retention nomogram model calibration curve was aligned with the ideal curve. The ROC curve showed that the training and verification set AUCs were 0.819 (95% CI, 0.798-0.895) and 0.795 (95% CI, 0.782-0.824), respectively.

Conclusion: Our urinary retention nomogram based on independent risk factors has good accuracy and predictive ability.