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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 442 -449. doi: 10.3877/cma.j.issn.1674-392X.2025.04.015

所属专题： 文献；

论著

经腹腹膜前腹股沟疝修补术后尿潴留风险列线图预测模型的构建及验证
李康虎1,2, 刘凯1,2, 王继伟2,3, 王光远1,2,†()   
  1. 1553000　贵州，六盘水市人民医院普外科
    2563000　贵州，遵义医科大学第一临床学院
    3563000　贵州，遵义医科大学附属医院普外科
  • 收稿日期:2024-07-10 出版日期:2025-08-18
  • 通信作者: 王光远
  • 基金资助:
    吴阶平医学基金会临床科研专项基金(320.6750.2021-07-3)

Develop of a nomogram for predicting urinary retention after transabdominal preperitoneal inguinal hernia repair

Kanghu Li1,2, Kai Liu1,2, Jiwei Wang2,3, Guangyuan Wang1,2,†()   

  1. 1Department of General Surgery, Liupanshui People's Hospital, Liupanshui 553000, Guizhou Province, China
    2The First Clinical Institute, Zunyi Medical University, Zunyi 563000, Guizhou Province, China
    3Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
  • Received:2024-07-10 Published:2025-08-18
  • Corresponding author: Guangyuan Wang
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引用本文：

李康虎, 刘凯, 王继伟, 王光远. 经腹腹膜前腹股沟疝修补术后尿潴留风险列线图预测模型的构建及验证[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(04): 442-449.

Kanghu Li, Kai Liu, Jiwei Wang, Guangyuan Wang. Develop of a nomogram for predicting urinary retention after transabdominal preperitoneal inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(04): 442-449.

目的

探索经腹腹膜前腹股沟疝修补术（TAPP）后发生术后尿潴留（POUR）的独立危险因素，尝试构建TAPP后POUR发生风险的预测模型并评价其预测能力。

方法

采用回顾性病例对照研究，收集2017年1月至2023年12月于遵义医科大学附属六盘水市人民医院普外科行TAPP手术的598例腹股沟疝患者临床资料，按7∶3的分为训练集和验证集，训练集按是否发生POUR分为POUR组（38例），非POUR组（381例）。采用单因素、多因素Logistic回归分析筛选POUR的独立危险因素，构建列线图预测模型。在训练集和验证集评估模型预测能力，使用受试者工作特征（ROC）曲线分析计算曲线下面积（AUC）值评价模型区分度，使用校准曲线及Hosmer-Lemeshow检验评价模型校准度。采用决策曲线分析评估模型临床适用性。

结果

多因素Logistic回归分析提示发病情况（OR=0.279，95% CI 0.105~0.805；P=0.013）、良性前列腺增生（OR=15.09，95% CI 2.658~96.282；P=0.002）、手术时间（OR=1.015，95% CI 1.006~1.023；P<0.001）、使用麻醉性镇痛药物（OR=2.224，95% CI 1.021~5.222；P=0.048）是TAPP后发生POUR的独立危险因素，留置导尿（OR=0.087，95% CI 0.012~0.370；P=0.004）是POUR的保护因素。区分度评价提示训练集的AUC为0.763（95% CI 0.684~0.842；P<0.001），验证集的AUC为0.812（95% CI 0.677~0.947；P<0.001），两者AUC均大于0.75。校准度评价发现训练集Hosmer-Lemeshow检验结果（χ2=5.566，P=0.696），验证集Hosmer-Lemeshow检验结果（χ2=11.132，P=0.194）。

结论

复发疝、良性前列腺增生、未留置导尿、手术时间长、术后使用麻醉性镇痛药物是TAPP后发生POUR的独立危险因素，据此建立的POUR风险预测列线图模型具有较强的预测能力，该模型有助于临床医师早期识别POUR高危患者，及时采取防治措施。

关键词: 经腹腹膜前腹股沟疝修补术, 术后尿潴留, 前列腺增生, 危险因素, 列线图模型
Objective

To identify independent risk factors for postoperative urinary retention (POUR) following transabdominal preperitoneal inguinal hernia repair (TAPP), and to develop and evaluate a predictive model for POUR risk.

Methods

Clinical data of 598 patients who underwent TAPP for inguinal hernia in the Department of General Surgery, Affiliated Liupanshui People's Hospital of Zunyi Medical University, from January 2017 to December 2023 were retrospectively collected. Patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. In the training cohort, patients were grouped into the POUR group (n=38) and the non-POUR group (n=381) according to the occurrence of POUR. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POUR, and a nomogram prediction model was constructed. Model performance was assessed in both cohorts. Discrimination was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC), calibration was assessed using calibration plots and the Hosmer-Lemeshow goodness-of-fit test, and clinical utility was analyzed using decision curve analysis (DCA).

Results

Multivariate logistic regression analysis revealed that recurrence status (OR=0.279, 95% CI: 0.105-0.805; P=0.013), benign prostatic hyperplasia (BPH) (OR=15.09, 95% CI: 2.658-96.282; P=0.002), operative duration (OR=1.015, 95% CI: 1.006-1.023; P<0.001), and postoperative use of opioid analgesics (OR=2.224, 95% CI: 1.021-5.222; P=0.048) were independent risk factors for POUR after TAPP, whereas intraoperative urinary catheterization (OR=0.087, 95% CI: 0.012-0.370; P=0.004) was a protective factor. In terms of discrimination, the AUC was 0.763 (95% CI: 0.684-0.842; P<0.001) in the training cohort and 0.812 (95% CI: 0.677-0.947; P<0.001) in the validation cohort, both exceeding 0.75. Calibration assessment showed good agreement, with Hosmer-Lemeshow test results of χ2=5.566 (P=0.696) for the training cohort and χ2=11.132 (P=0.194) for the validation cohort.

Conclusion

Recurrent hernia, benign prostatic hyperplasia, absence of urinary catheterization, prolonged operative time, and postoperative opioid analgesic use are independent risk factors for POUR after TAPP. The nomogram model established based on these factors demonstrated good predictive performance and may assist clinicians in early identification of high-risk patients, enabling timely preventive and therapeutic interventions.

Key words: Transabdominal preperitoneal inguinal hernia repair, Postoperative urinary retention, Prostatic hyperplasia, Risk factors, Nomogram model
图1 患者入组流程图注：TAPP为经腹腹膜前腹股沟疝修补术；POUR为术后尿潴留。
表1 训练集和验证集一般资料比较
组别 例数 年龄[岁, M(Q1, Q3)] BMI[kg/m2, M(Q1, Q3)] 疝内环口直径[cm, M(Q1, Q3)] 术中补液量[mL, M(Q1, Q3)] 手术时间[min, M(Q1, Q3)] 麻醉时间[min, M(Q1, Q3)]
训练集 419 52(44, 60) 23.0(21.3, 25.1) 3.0(2.5, 4.0) 1500(1250, 2000) 91.0(70.0, 116.5) 130(105, 160)
验证集 179 52(43, 60) 22.8(21.1, 25.2) 3.0(2.5, 4.0) 1500(1400, 2000) 85.0(70.0, 113.5) 130(105, 155)
χ2/Z值   0.424 0.646 0.645 0.973 0.464 0.195
P值   0.671 0.518 0.519 0.331 0.643 0.845
组别 例数 性别[例(%)] 吸烟史[例(%)] 饮酒史[例(%)] 基础疾病[例(%)] 前列腺增生[例(%)] 发病情况[例(%)]
女性 男性 否 是 否 是 否 是 否 是 复发疝 初发疝
训练集 419 37(8.8) 382(91.2) 209(50) 210(50) 375(89) 44(11) 373(89) 46(11) 409(98) 10(2.4) 31(7.4) 388(93)
验证集 179 18(10) 161(90) 102(57) 77(43) 163(91) 16(8.9) 159(89) 20(11) 176(98) 3(1.7) 15(8.4) 164(92)
χ2/Z值   0.225 2.535 0.339 0.005 0.057 0.170
P值   0.635 0.111 0.56 0.945 0.811 0.680
组别 例数 留置导尿[例(%)] ASA分级[例(%)] 疝部位[例(%)] 疝类型[例(%)] 补片类型[例(%)] 使用麻醉性镇痛药物[例(%)]
否 是 Ⅰ Ⅱ~Ⅲ 双侧 单侧 复合疝 直疝 股疝 斜疝 生物补片 非生物补片 否 是
训练集 419 313(75) 106(25) 171(41) 248(59) 181(43) 238(57) 55(13) 76(18) 24(5.7) 264(63) 395(94) 24(5.7) 207(49) 212(51)
验证集 179 131(73) 48(27) 88(49) 91(51) 65(36) 114(64) 17(9.5) 41(23) 6(3.4) 115(64) 167(93) 12(6.7) 93(52) 86(48)
χ2/Z值   0.151 3.562 2.455 4.270 0.211 0.327
P值   0.698 0.059 0.117 0.234 0.646 0.568
表2 训练集TAPP术后POUR单因素分析
组别 例数 性别[例(%)] 年龄[例(%)] 体重指数[例(%)] 吸烟史[例(%)] 饮酒史[例(%)] 基础疾病[例(%)]
女性 男性 <60岁 ≥60岁 <24.0 kg/m2 ≥24.0 kg/m2 否 是 否 是 否 是
非POUR组 381 35(9) 346(91) 334(88) 47(12) 246(65) 135(35) 195(51) 186(49) 342(90) 39(10) 341(90) 40(10)
POUR组 38 2(5) 36(95) 32(84) 6(16) 23(61) 15(39) 14(37) 24(63) 33(87) 5(13) 32(84) 6(16)
χ2/Z值   0.126 0.126 0.245 2.842 0.079 0.522
P值   0.608 0.723 0.62 0.092 0.777 0.47
组别 例数 良性前列腺增生[例(%)] 发病情况[例(%)] 疝部位[例(%)] 疝类型[例(%)] 留置导尿[例(%)] ASA分级[例(%)]
否 是 复发疝 初发疝 双侧 单侧 复合疝 直疝 股疝 斜疝 否 是 Ⅰ Ⅱ~Ⅲ
非POUR组 381 376(99) 5(1) 21(6) 360(94) 159(42) 222(58) 48(13) 70(18) 24(6) 239(63) 278(73) 103(27) 156(41) 225(59)
POUR组 38 33(87) 5(13) 10(26) 28(74) 22(58) 16(42) 7(18) 6(16) 0(0) 25(66) 35(92) 3(8) 15(39) 23(61)
χ2/Z值   16.038 18.897 3.678   6.698 0.031
P值   <0.001 <0.001 0.055 0.334 0.009 0.86
组别 例数 疝内环口直径[例(%)] 补片类型[例(%)] 术中补液量[例(%)] 使用麻醉性镇痛药物[例(%)] 手术时间[min, M(Q1, Q3)] 麻醉时间[min, M(Q1, Q3)]
<3.0 cm ≥3.0 cm 非生物补片 生物补片 <1500 ml ≥1500 ml 否 是
非POUR组 381 242(64) 139(36) 359(94) 22(5.8) 248(65) 133(35) 197(52) 184(48) 90(70,115) 130(105,158)
POUR组 38 17(45) 21(55) 36(95) 2(5) 20(53) 18(47) 10(26) 28(74) 109.5(77,140) 155(115,183)
χ2/Z值   5.163 <0.001 2.327 8.911 -2.715 -2.243
P值   0.023 1.000 0.127 0.003 0.007 0.025
表3 训练集TAPP术后POUR多因素分析
因素 回归系数 标准误 Z P值 OR 95% CI
初发疝 -1.275 0.514 -2.480 0.013 0.279 0.105~0.805
使用麻醉性镇痛药物 0.799 0.412 1.939 -0.048 2.224 1.021~5.222
前列腺增生 2.714 0.892 3.041 0.002 15.093 2.658~96.282
留置导尿 -2.437 0.849 -2.870 0.004 0.087 0.012~0.370
疝内环口直径 0.210 0.400 0.530 0.599 1.243 0.561~2.740
手术时间 0.015 0.004 3.462 <0.001 1.015 1.006~1.023
麻醉时间 0.001 0.010 0.073 0.942 1.001 0.981~1.023
图2 TAPP后发生POUR的列线图预测模型注：TAPP为经腹腹膜前腹股沟疝修补术；POUR为术后尿潴留。
图3 模型预测TAPP后分是否发生POUR的ROC曲线注：3A为训练集；3B为验证集。TAPP为经腹腹膜前腹股沟疝修补术；POUR为术后尿潴留；ROC曲线为受试者工作特征曲线。
图4 TAPP后发生POUR风险预测模型校准曲线注：4A为训练集；4B为验证集。TAPP为经腹腹膜前腹股沟疝修补术；POUR为术后尿潴留。
图5 TAPP后发生POUR风险预测模型的决策曲线注：5A为训练集；5B为验证集讨论。TAPP为经腹腹膜前腹股沟疝修补术；POUR为术后尿潴留。
[1]
The HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[2]
Fitzgibbons RJ, Ramanan B, Arya S, et al. Long-term results of a randomized controlled trial of a nonoperative strategy(watchful waiting) for men with minimally symptomatic inguinal hernias[J]. Ann Surg, 2013, 258(3): 508-515.
[3]
Poulose BK, Shelton J, Phillips S, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research[J]. Hernia, 2012, 16(2): 179-183.
[4]
Sivasankaran MV, Pham T, Divino CM. Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair[J]. Am J Surg, 2014, 207(2): 288-292.
[5]
Shalaby R, Abd Alrazek M, Elsaied A, et al. Fifteen Years experience with laparoscopic inguinal hernia repair in infants and children[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(1): 101-105.
[6]
Unal Y, Kilinc MF. Does inguinal hernia repair affect uroflowmetric parameters? A prospective controlled clinical trial[J]. Lower Urinary Tract Symptoms, 2019, 11(3): 99-103.
[7]
Hall BR, Armijo PR, Grams B, et al. Identifying patients at risk for urinary retention following inguinal herniorrhaphy: a single institution study[J]. Hernia, 2019, 23(2): 311-315.
[8]
Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair[J]. Am J Surg, 2006, 191(3): 381-385.
[9]
Crain N, Tejirian T. Impact of Intraoperative foley catheters on postoperative urinary retention after inguinal hernia surgery[J]. Am Surg, 2019, 85(10): 1099-1103.
[10]
Goldman G, Leviav A, Mazor A, et al. Alpha-adrenergic blocker for posthernioplasty urinary retention. Prevention and treatment[J]. Arch Surg, 1988, 123(1): 35-36.
[11]
Durant PAC, Yaksh TL. Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized rats[J]. Anesthesiology, 1988, 68(3): 325-334.
[12]
Patel JA, Kaufman AS, Howard RS, et al. Risk factors for urinary retention after laparoscopic inguinal hernia repairs[J]. Surg Endosc, 2015, 29(11): 3140-3145.
[13]
Caparelli ML, Shikhman A, Runyan B, et al. The use of tamsulosin to prevent postoperative urinary retention in laparoscopic inguinal hernia repair: a randomized double-blind placebo-controlled study[J]. Surg Endosc, 2021, 35(10): 5538-5545.
[14]
Bojaxhi E, Lee J, Bowers S, et al. Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair[J]. Hernia, 2018, 22(5): 871-879.
[15]
Drahman A, Ngee-Soon SL, Crawford M. Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis[J]. Hernia, 2023, 27(6): 1351-1361.
[16]
Clancy C, Coffey JC, O’Riordain MG, et al. A meta-analysis of the efficacy of prophylactic alpha-blockade for the prevention of urinary retention following primary unilateral inguinal hernia repair[J]. Am J Surg, 2018, 216(2): 337-341.
[17]
Hudak KE, Frelich MJ, Rettenmaier CR, et al. Surgery duration predicts urinary retention after inguinal herniorrhaphy: a single institution review[J]. Surg Endosc, 2015, 29(11): 3246-3250.
[18]
Roadman D, Helm M, Goldblatt MI, et al. Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair[J]. J Surg Res, 2018, 231: 309-315.
[19]
Di Natale S, Slieker J, Soppe S, et al. Risk Factors for postoperative urinary retention after endoscopic hernia repair: age and unilateral operation make the difference[J]. World J Surg, 2021, 45(12): 3616-3622.
[20]
Croghan SM, Mohan HM, Breen KJ, et al. Global Incidence and risk factors associated with postoperative urinary retention following elective inguinal hernia repair: the retention of urine after inguinal hernia elective repair(RETAINER I) study[J]. JAMA Surg, 2023, 158(8): 865-873.
[21]
Akaike H. A new look at the statistical model identification[J]. IEEE Trans Autom Control, 1974, 19(6): 716-723.
[22]
Blair AB, Dwarakanath A, Mehta A, et al. Postoperative urinary retention after inguinal hernia repair: a single institution experience [J]. Hernia, 2017, 21(6): 895-900.
[23]
Aleman R, Blanco DG, Funes DR, et al. Does transverse abdominis plane block increase the risk of postoperative urinary retention after inguinal hernia repair?[J]. JSLS, 2021, 25(4): e2021. 15.
[24]
Koukoulis GD, Bouliaris K, Perivoliotis K, et al. Prophylactic administration of alpha blocker for the prevention of urinary retention in males undergoing inguinal hernia repair under spinal anesthesia: interim analysis of a randomized controlled trial[J]. Cureus, 2021, 13(11): e19669.
[25]
Kim HS, Go TH, Kang DR, et al. The prevalence of benign prostate hyperplasia in Korea: using national health insurance service data[J]. J Health Info Stat, 2018, 43(3): 208-216.
[26]
Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations[J]. Anesthesiology, 2009, 110(5): 1139-1157.
[27]
Brahmachari S. Comparison between in/out and overnight catheterization as management of post operative urinary retention: randomized trial[J]. Asian J Biomed Pharm Sci, 2023, 3: 27-29.
[28]
Rimmer MP, Henderson I, Keay SD, et al. Early versus delayed urinary catheter removal after hysterectomy: a systematic review and meta-analysis[J]. Eur J Obstet Gyn R B, 2020, 247: 55-60.
[29]
Denham M, Donovan K, Wetoska N, et al. Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair[J]. Surg Endosc, 2019, 33(9): 3008-3013.
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