Development and validation of nomogram models for predicting urinary incontinence following radical prostatectomy in high-risk prostate cancer patients

To develop a risk stratification model for predicting urinary incontinence following radical prostatectomy (RP) in high-risk prostate cancer patients based on their clinicopathological characteristics. A retrospective analysis was conducted on 520 prostate cancer patients who underwent RP between January 2016 and January 2024. Baseline characteristics, pathological data, laboratory parameters, and surgery-related factors were collected. Urinary continence status at 1, 3, and 6 months postoperatively was assessed. Multivariate logistic regression analyses were performed to identify independent risk factors, and nomograms were constructed to predict urinary incontinence risk at each time point. Urinary incontinence rates at 1, 3, and 6 months postoperatively were 92.88%, 69.62%, and 23.65%, respectively. At 1 month, a higher Gleason score (OR=2.178, P=0.003) was a risk factor, while robot-assisted surgery was protective (OR=0.289, P=0.003). At 3 months, higher Gleason score (OR=1.565, P=0.004) increased risk, whereas lower BMI (<25 kg/m2) (OR=0.448, P=0.005) and longer preoperative membranous urethral length (≥14 mm) (OR=2.368, P<0.001) were protective. At 6 months, shorter membranous urethral length (<14 mm) (OR=3.622, P<0.001), neoadjuvant hormone therapy (OR=5.783, P<0.001), and higher Gleason score (OR=2.824, P<0.001) were risk factors, while lower BMI (OR=0.317, P<0.001), smaller prostate volume (<40 mL) (OR=0.591, P=0.044), and lower CONUT score (<4) (OR=0.372, P<0.001) were protective. The nomograms showed good predictive performance, with AUCs of 0.679 at 3 months and 0.818 at 6 months. The developed nomograms effectively stratify the risk of urinary incontinence following RP in high-risk patients, facilitating individualized perioperative management and rehabilitation strategies.