Relationship between the length and three-dimensional morphology of intravesical prostatic protrusion and hematuria,and the construction of its Nomogram model

WANG Ya-fei; JI Jian; CHEN Lyu-yang; YANG Tian-can; LEI Ling-min; GAO Xiao-wen; ZHU Yuan-quan; FAN Shi-cheng; CUI Qing-peng; WU Zhi-da; PU Wei

doi:10.11659/jjssx.12E024121

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Relationship between the length and three-dimensional morphology of intravesical prostatic protrusion and hematuria,and the construction of its Nomogram model

Clinical Research | 更新时间：2025-12-22

- Relationship between the length and three-dimensional morphology of intravesical prostatic protrusion and hematuria,and the construction of its Nomogram model
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 12, Pages: 1096-1101(2025)
- 作者机构：
  
  云南省第三人民医院/大理大学第二附属医院泌尿外科，云南昆明 650011
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.12E024121
  CLC： R697+.32
- Received：20 December 2024，
  
  Published：25 December 2025
- 稿件说明：
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王亚飞,季健,陈旅阳等.膀胱内前列腺突入长度和三维形态与血尿的关系及其Nomogram模型构建[J].局解手术学杂志,2025,34(12):1096-1101.

WANG Ya-fei,JI Jian,CHEN Lyu-yang,et al.Relationship between the length and three-dimensional morphology of intravesical prostatic protrusion and hematuria,and the construction of its Nomogram model[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(12):1096-1101.
王亚飞,季健,陈旅阳等.膀胱内前列腺突入长度和三维形态与血尿的关系及其Nomogram模型构建[J].局解手术学杂志,2025,34(12):1096-1101. DOI： 10.11659/jjssx.12E024121.

WANG Ya-fei,JI Jian,CHEN Lyu-yang,et al.Relationship between the length and three-dimensional morphology of intravesical prostatic protrusion and hematuria,and the construction of its Nomogram model[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(12):1096-1101. DOI： 10.11659/jjssx.12E024121.

摘要

目的

探讨膀胱内前列腺突入(IPP)长度及三维形态对良性前列腺增生（BPH）患者血尿的影响，并构建相关Nomogram模型。

方法

回顾性分析2023年1月至2024年8月我院泌尿外科收治的198例BPH患者的临床资料，经腹超声测量IPP长度，根据IPP长度将患者分为IPP≤10 mm组、10 mm

IPP

20 mm组、IPP≥20 mm组。另根据经腹超声正中矢状面上IPP的不同三维形态将患者分为类球形突入组、拇指形突入组、M形突入组。根据是否发生血尿，对前列腺体积（PV）、膀胱壁厚度（BWT）、残余尿量（PVR）、国际前列腺症状评分（IPSS）、生活质量（QOL）评分、急性尿潴留及膀胱壁回声异常等变量进行单因素分析及多因素

Logistic

回归分析，通过受试者工作特征（

ROC

）曲线、校准曲线及决策曲线（

DCA

）评估Nomogram模型的准确性及临床实用性。

结果

10 mm

IPP

20 mm组患者血尿与严重血尿发生率显著高于IPP≤10 mm组（

0.05）；IPP≥20 mm组患者严重血尿致膀胱填塞发生率显著高于IPP≤10 mm组（

0.05）。拇指形突入组患者血尿、严重血尿及严重血尿致膀胱填塞发生率均显著高于类球形突入组（

0.05）；M形突入组患者血尿和严重血尿发生率显著高于类球形突入组（

0.05）。多因素

Logistic

回归分析显示，拇指形突入、M形突入、QOL评分升高、膀胱壁回声异常是BPH患者发生血尿的独立危险因素（

0.05），IPP≥20 mm是BPH患者发生血尿的保护因素（

0.05）。Nomogram模型验证结果显示：一致性指数（

index）

为0.796，校正曲线趋近于理想曲线，

ROC

曲线下面积（

AUC

）为0.796 （95%

:0.735～0.857）；

DCA

结果显示：模型在4%～93%范围内，列线图预测BPH患者发生血尿的风险净获益值较高，具有良好的临床预测能力。

结论

拇指形突入、M形突入、IPP≥20 mm、QOL评分升高、膀胱壁回声异常与BPH患者发生血尿有关，基于以上因素构建的Nomogram模型对BPH患者发生血尿的预测效能较好，具有早期识别高风险患者的潜力，有一定的临床应用价值。

Abstract

Objective

To investigate the impact of the length and three-dimensional morphology of intravesical prostatic protrusion （IPP） on hematuria in patients with benign prostatic hyperplasia （BPH），and to construct a relevant Nomogram model.

Methods

The clinical data of 198 BPH patients admitted to department of urology of our hospital from January 2023 to August 2024 were retrospectively analyzed. The IPP length was measured by transabdominal ultrasound，and the patients were divided into IPP≤10 mm group，10 mm

IPP

20 mm group and IPP≥20 mm group according to the IPP length. In addition，according to the different three-dimensional morphology of IPP on the median sagittal plane of transabdominal ultrasound，the patients were divided into globular protrusion group，thumb-shaped protrusion group and M-shaped protrusion group. According to whether hematuria occurred or not，the variables such as prostate volume （PV），bladder wall thickness （BWT），post-void residual （PVR），international prostate symptom score（IPSS），quality of life （QOL） score，acute urinary retention and abnormal bladder wall echogenicity were analyzed by univariate analysis and multivariate

Logistic

regression analysis，and the accuracy and clinical practicability of Nomogram model were evaluated by the

receiver operating characteristic

（

ROC

） curve，

calibration curve

and

decision curve analysis

（

DCA

）.

Results

The incidence of hematuria and severe hematuria of patients in 10 mm

IPP

20 mm group was significantly higher than that in IPP≤10 mm group （

0.05）. The incidence of severe hematuria-induced bladder tamponade of patients in IPP≥20 mm group was significantly higher than that in IPP≤10 mm group （

0.05）. The incidences of hematuria，severe hematuria and severe hematuria-induced bladder tamponade in thumb-shaped protrusion group were significantly higher than those in globular protrusion group （

0.05）. The incidences of hematuria and severe hematuria in M-shaped protrusion group were significantly higher than those in globular protrusion group （

0.05）. Multivariate

Logistic

regression analysis revealed that the thumb-shaped protrusion，M-shaped protrusion，increased QOL score，and abnormal bladder wall echogenicity were the independent risk factors for hematuria in BPH patients （

0.05），whereas IPP≥20 mm served as a protective factor （

0.05）. The validation results of Nomogram model showed that the

concordance index

（

C-index

） was 0.796，the calibration curve approaching the ideal curve，and the

area under the ROC curve

（

AUC

） curve was 0.796 （95%

：0.735 to 0.857）.

DCA

results showed that the Nomogram model had a higher net benefit value in predicting the risk of hematuria in BPH patients within the range of 4% to 93%，indicating that the model has good clinical predictive ability.

Conclusion

The thumb-shaped protrusion，M-shaped protrusion，IPP≥20 mm，increased QOL score，and abnormal bladder wall echogenicity were associated with the occurrence of hematuria in patients with BPH，the Nomogram model constructed based on the above factors has good prediction efficiency for hematuria in BPH patients，which has the potential to identify high-risk patients at an early stage and has certain clinical application value.

关键词

Keywords

references

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