title: A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery.
abstract: OBJECTIVE
  To construct and validate a prediction model for estimating the risk of de novo stress urinary incontinence (SUI) after vaginal pelvic organ prolapse (POP) surgery and compare it with predictions using preoperative urinary stress testing and expert surgeons' predictions.
  
  
  METHODS
  Using the data set (n=457) from the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial, a model using 12 clinical preoperative predictors of de novo SUI was constructed. De novo SUI was determined by Pelvic Floor Distress Inventory responses through 12 months postoperatively. After fitting the multivariable logistic regression model using the best predictors, the model was internally validated with 1,000 bootstrap samples to obtain bias-corrected accuracy using a concordance index. The model's predictions were also externally validated by comparing findings against actual outcomes using Colpopexy and Urinary Reduction Efforts trial patients (n=316). The final model's performance was compared with experts using a test data set of 32 randomly chosen Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial patients through comparison of the model's area under the curve against: 1) 22 experts' predictions; and 2) preoperative prolapse reduction stress testing.
  
  
  RESULTS
  A model containing seven predictors discriminated between de novo SUI status (concordance index 0.73, 95% confidence interval [CI] 0.65-0.80) in Outcomes Following Vaginal Prolapse Repair and Midurethral Sling participants and outperformed expert clinicians (area under the curve 0.72 compared with 0.62, P<.001) and preoperative urinary stress testing (area under the curve 0.72 compared with 0.54, P<.001). The concordance index for Colpopexy and Urinary Reduction Efforts trial participants was 0.62 (95% CI 0.56-0.69).
  
  
  CONCLUSIONS
  This individualized prediction model for de novo SUI after vaginal POP surgery is valid and outperforms preoperative stress testing, prediction by experts, and preoperative reduction cough stress testing. An online calculator is provided for clinical use.
  
  
  METHODS
  III.
authors.affiliation: Obstetrics, Gynecology & Women's Health Institute and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; the Department of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois; the Departments of Obstetrics and Gynecology and Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; the Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, University of Pennsylvania, Philadelphia, Pennsylvania, University of Utah, Salt Lake City, Utah, Women and Infants Hospital, Providence, Rhode Island, Kaiser Permanente, San Diego, California, and Duke University Medical Center, Durham, North Carolina; the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; RTI International, Research Triangle Park, North Carolina; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Kevin
authors.initials: K
authors.lastname: Chagin
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Lily
authors.initials: L
authors.lastname: Arya
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Nolen
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.forename: Vivian
authors.initials: V
authors.lastname: Sung
authors.forename: Shawn
authors.initials: S
authors.lastname: Menefee
authors.forename: Nazema
authors.initials: N
authors.lastname: Siddiqui
authors.forename: Susan F
authors.initials: SF
authors.lastname: Meikle
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*