Construction and Validation of a Nomogram for Diagnosis of Female Stress Urinary Incontinence Combined with...

In order to improve the diagnostic accuracy of anatomical/intrinsic sphincter deficiency (ISD) in female patients with stress urinary incontinence (SUI) and to provide a reference for surgical approaches, we developed a nomogram model based on urodynamic parameters.

Clinical data from 1150 women with complicated SUI treated at the Department of Urology, Third Xiangya Hospital, Central South University (01/01/2017-10/30/2023) were retrospectively analyzed. Patients were randomly divided into a training cohort (805 cases, 70%) and a validation cohort (345 cases, 30%). ISD was diagnosed by maximum urethral closure pressure (MUCP <30 cmH₂O) or Valsalva leak point pressure (VLPP ≤60 cmH₂O). Independent predictors of ISD were identified in the training cohort using binary logistic regression to construct the nomogram, validated using the validation cohort.

Multivariate analysis identified abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP as independent predictors of ISD. The nomogram demonstrated good discrimination: training cohort AUC = 0.8308 (95% CI: 0.8022-0.8604); validation cohort AUC = 0.8408 (95% CI: 0.7964-0.8844). Decision curve analysis (DCA) indicated significant clinical benefit for both cohorts.

This urodynamic parameter-based nomogram (incorporating abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP) provides higher diagnostic accuracy for identifying anatomical/structural differences (ISD) in women with complicated SUI compared to traditional criteria (MUCP <30 cmH₂O or VLPP ≤60 cmH₂O), providing important references for the selection of surgical approaches.