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P.I. nomogram: an exploratory imaging-derived model for predicting early urinary incontinence following ThuLEP
Xiao-Da Lan1,2, Rui Jiang1, He Wang3
1Department of Urology, Institute of Urology, National Research Center for Genitourinary Oncology, Peking University First Hospital, Peking University, Beijing, 100034, China.
World Journal of Urology
|January 23, 2026
Summary
Urinary incontinence after prostate surgery can be predicted using prostatic apex shape and intravesical prostatic protrusion. This new nomogram helps estimate short-term risk for patients undergoing thulium laser enucleation of the prostate (ThuLEP).
Area of Science:
- Urology
- Medical Imaging
- Surgical Outcomes
Background:
- Early postoperative urinary incontinence (UI) significantly impacts quality of life after thulium laser enucleation of the prostate (ThuLEP).
- Predictive models for UI following ThuLEP are currently lacking.
- Prostatic apex shape (PAS), explored in prostate cancer, is underexplored for predicting outcomes in benign prostatic hyperplasia (BPH).
Purpose of the Study:
- To develop a nomogram using prostatic apex shape (PAS) and clinical parameters to estimate short-term UI risk after ThuLEP.
- To provide a noninvasive tool for preoperative risk stratification and patient counseling.
Main Methods:
- Retrospective analysis of 106 patients who underwent ThuLEP for BPH.
- Classification of PAS into four subtypes (A-D) using MRI.
- Logistic regression to identify predictors of UI, including intravesical prostatic protrusion (IPP).
- Development and evaluation of a nomogram using AUC, calibration, and decision curve analysis.
Main Results:
- Early UI at 1 month occurred in 37.7% of patients.
- PAS types A-C (OR 11.721) and IPP > 2.4 cm (OR 11.543) were independent predictors of UI.
- The developed nomogram (PAS, IPP) achieved an AUC of 0.758 with good calibration.
Conclusions:
- Prostatic apex shape types A-C and IPP > 2.4 cm are independently associated with 1-month UI after ThuLEP.
- The P.I. nomogram demonstrates acceptable discrimination and calibration for short-term UI risk.
- This tool may aid preoperative risk stratification and counseling for patients undergoing ThuLEP.
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