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Predictive approach in managing voiding dysfunction after surgery for deep endometriosis: a personalized nomogram.

Elie Vesale1, Horace Roman2, Carole Abo3

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Summary

A new nomogram predicts voiding dysfunction after deep endometriosis surgery. This tool helps inform patients and tailor surgical strategies based on individual risk factors like age and extent of disease.

Keywords:
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Area of Science:

  • Gynecology
  • Urology
  • Surgical Oncology

Background:

  • Deep endometriosis is a debilitating condition requiring complex surgical intervention.
  • Surgery for deep endometriosis, particularly with colorectal involvement, carries risks of postoperative complications, including voiding dysfunction.

Purpose of the Study:

  • To develop and validate a predictive nomogram for postoperative voiding dysfunction following deep endometriosis surgery.
  • To identify key clinical and surgical factors associated with the risk of voiding dysfunction.

Main Methods:

  • Retrospective analysis of 789 patients undergoing surgery for deep endometriosis with colorectal involvement (training set).
  • Multivariate logistic regression to identify risk factors and construct a predictive nomogram.
  • External validation of the nomogram in an independent cohort of 333 patients.

Main Results:

  • Postoperative voiding dysfunction occurred in 23% of the training set patients.
  • Key predictors for voiding dysfunction included age, colorectal involvement/management, colpectomy, and parametrectomy.
  • The nomogram demonstrated good predictive accuracy with an internal concordance index of 0.79 and external validation ROC area of 0.74.

Conclusions:

  • The developed nomogram, based on four clinical and imaging characteristics, can predict postoperative voiding dysfunction in women undergoing deep endometriosis surgery.
  • This tool can aid in patient counseling regarding surgical risks and inform individualized surgical planning.
  • While externally validated, further validation studies are recommended to confirm its utility.