Risk factors of urinary retention after external stripping and internal ligation of mixed hemorrhoids and construction of a prediction model
Objective To investigate the risk factors of urinary retention after external stripping and internal ligation of mixed hemorrhoids and to construct a prediction model.Methods Clinical data of 532 patients with mixed hemorrhoids who underwent exter-nal stripping and internal ligation treatment at the 908th Hospital of PLA Joint Logistics Support Force from December 2018 to Novem-ber 2023 in our hospital were collected,and the patients were categorized into urinary retention group(n=62)and non-urinary reten-tion group(n=470)according to whether urinary retention occurred after surgery.The optimal cut-off values of each factor were ana-lyzed by receiver operating characteristic(ROC)curve.logistic multiple regression model was used to analyze the independent risk factors for the occurrence of urinary retention after external stripping and internal ligation of mixed hemorrhoids and to construct a pre-diction model,the correction curve was used to internally validate the prediction model,and decision curve was used to assess the pre-dictive efficacy of the prediction model.Results There was no statistically significant difference between the two groups in terms of gender,BMI,marital status,and anal fissure(P>0.05);the age,proportion of comorbid diabetes mellitus,proportion of epidural an-esthesia,proportion of constipation,HAMA score,VAS score,number of points of ligated internal hemorrhoids,and operative time of the urinary retention group were higher than those of the non-urinary retention group,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the optimal cut-off values for age,HAMA score,VAS score,number of points for lancing internal hemorrhoids,and operative time were 60 years,13 points,6 points,3,and 40 min,respectively.Logistic multiple regression model showed that age(>60 years),comorbid diabetes mellitus(yes),constipation(yes),HAMA score(>13),VAS score(>6),and operative time(>40 min)were the independent risk factors for the development of urinary retention after the excision of mixed hemorrhoids(P<0.05).Internal validation showed that the C-index of the prediction model for predicting the occurrence of urinary reten-tion after the excision of mixed hemorrhoids was 0.957(0.929-0.985).The agreement between observed and predicted values was good.The prediction model predicted a threshold of>0.22 for the occurrence of urinary retention after external and internal ligation ex-cision of mixed hemorrhoids,and the prediction model provided a net clinical benefit over age,comorbid diabetes,constipation,HA-MA score,VAS score,and operative time.Conclusions In this study,a prediction model is constructed to predict the occurrence of urinary retention after external stripping and internal ligation of mixed hemorrhoids based on age,comorbid diabetes mellitus,constipa-tion,HAMA score,VAS score,and operation time,which has a good predictive value for the occurrence of urinary retention after the resection,and can provide a basis for clinical improvement of patients'prognosis.
mixed hemorrhoidexternal stripping and internal ligationurinary retentionrisk factorprediction model
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