A web-based fuzzy risk predictive-decision model of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery.

BACKGROUND: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions affecting women's health and quality of life. In 50% of cases, SUI occurs after POP surgery, which is called de novo SUI. Predicting the risk of de novo SUI is a complex multi-attribute decision-making process. The current study made available a Decision Support System in the form of a fuzzy calculator web-based application to help surgeons predict the risk of de novo SUI. MATERIALS AND METHODS: We first identified 12 risk factors and the diagnostic criteria for de novo SUI by means of a systematic review of the literature. Then based upon an expert panel, all risk factors were prioritized. A set of 232 fuzzy rules for the prediction of de novo SUI was determined. A fuzzy expert system was developed using MATLAB software and Mamdani Inference System. The risk prediction model was then evaluated using retrospective data extracted from 30 randomly selected medical records of female patients over the age of 50 without symptoms of urinary incontinence who had undergone POP surgery. Finally, the proposed results of the predictive system were compared with the results of retrospective medical record data review. RESULTS: The results of this online calculator show that the accuracy of this risk prediction model, at more than 90%, compared favorably to other SUI risk prediction models. CONCLUSIONS: A fuzzy logic-based clinical Decision Support System in the form of an online calculator for calculating SUI prognosis after POP surgery in women can be helpful in predicting de novo SUI.

Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review.

OBJECTIVE: Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review. MATERIAL AND METHODS: We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest. RESULTS: The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH2O. CONCLUSION: Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.