title: Anatomical Cystocele Recurrence: Development and Internal Validation of a Prediction Model.
abstract: OBJECTIVE
  To develop a prediction model that estimates the risk of anatomical cystocele recurrence after surgery.
  
  
  METHODS
  The databases of two multicenter prospective cohort studies were combined, and we performed a retrospective secondary analysis of these data. Women undergoing an anterior colporrhaphy without mesh materials and without previous pelvic organ prolapse (POP) surgery filled in a questionnaire, underwent translabial three-dimensional ultrasonography, and underwent staging of POP preoperatively and postoperatively. We developed a prediction model using multivariable logistic regression and internally validated it using standard bootstrapping techniques. The performance of the prediction model was assessed by computing indices of overall performance, discriminative ability, calibration, and its clinical utility by computing test characteristics.
  
  
  RESULTS
  Of 287 included women, 149 (51.9%) had anatomical cystocele recurrence. Factors included in the prediction model were assisted delivery, preoperative cystocele stage, number of compartments involved, major levator ani muscle defects, and levator hiatal area during Valsalva. Potential predictors that were excluded after backward elimination because of high P values were age, body mass index, number of vaginal deliveries, and family history of POP. The shrinkage factor resulting from the bootstrap procedure was 0.91. After correction for optimism, Nagelkerke's R and the Brier score were 0.15 and 0.22, respectively. This indicates satisfactory model fit. The area under the receiver operating characteristic curve of the prediction model was 71.6% (95% confidence interval 65.7-77.5). After correction for optimism, the area under the receiver operating characteristic curve was 69.7%.
  
  
  CONCLUSIONS
  This prediction model, including history of assisted delivery, preoperative stage, number of compartments, levator defects, and levator hiatus, estimates the risk of anatomical cystocele recurrence.
authors.affiliation: Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Clinical Epidemiology and Medical Technology Assessment (KEMTA) and Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, and Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, the Netherlands.
authors.forename: Tineke F M
authors.initials: TF
authors.lastname: Vergeldt
authors.forename: Sander M J
authors.initials: SM
authors.lastname: van Kuijk
authors.forename: Kim J B
authors.initials: KJ
authors.lastname: Notten
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: Mirjam
authors.initials: M
authors.lastname: Weemhoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D009426:Netherlands; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D053825:Suburethral Slings; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods