Predictive Nomogram for Reducing Urinary Tract Infection-Related Cancellations in Female Urodynamic Testing

Same-day cancellation of office-based urodynamic testing, frequently due to urinary tract infections (UTIs), can introduce financial and strategical burdens for both the patient and the clinic.

This study aimed to develop and internally validate a clinical prediction model for urodynamic procedure cancellation due to suspected UTI.

This retrospective cohort study included patients scheduled for urodynamic testing at a single academic urogynecology practice (August 1, 2022, to April 30, 2024). Data was collected via electronic medical record review. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation was used for variable selection. A clinical prediction nomogram and web-based calculator were developed for clinical implementation.

A total of 841 patients were included (mean age 63 ± 13.9 years; mean BMI 29.7 ± 6.7 kg/m²). UTI-related cancellation occurred in 57 (6.8%) patients. After LASSO selection, 5 predictors were retained: age, POP-Q stage, BMI, recurrent UTI history, and diabetes. The model demonstrated good apparent discrimination (C-statistic 0.759; sensitivity 75.4%, specificity 62.8%, NPV 97.4%) with a Brier score of 0.060. Full-process bootstrap validation revealed a calibration slope of 0.992. Decision curve analysis confirmed net clinical benefit across threshold probabilities of 2--40%.

Several variables predict suspected UTI-related urodynamic cancellation, the most significant of which is age. This nomogram and online calculator provide clinicians with practical tools for identifying patients at elevated risk of procedure cancellation, enabling targeted preprocedural intervention.