Risk factors for bladder spasms after radical prostatectomy for prostate cancer: A prospective study

Risk factors for bladder spasms after radical prostatectomy for prostate cancer: A prospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors for bladder spasms after radical prostatectomy for prostate cancer: A prospective study Chen Yu, Liao Chaoyu, Li Siyue, Zhou Luqiang, Guo Fang, Zheng Ji, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4521790/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Postoperative bladder spasms in prostate cancer patients have the potential to significantly impact their quality of life following surgery. It is essential to investigate the risk factors associated with bladder spasms in this patient population post-radical surgery to develop effective prevention strategies. Methods A prospective selection was conducted on 281 patients who underwent radical prostatectomy in our hospital from March 2022 to March 2024. They were divided into two groups based on whether bladder spasms occurred after surgery: the occurrence group ( n = 130) and the non occurrence group ( n = 151). Logistic regression analysis was performed on possible related factors to construct a column chart risk model. Another 43 prostate cancer patients who underwent radical surgery were selected to validate the model. Results The results of multivariate logistic regression analysis showed that preoperative anxiety, postoperative body temperature above 37.4, and flushing fluid speed > 150 drops/min were independent risk factors for bladder spasms in prostate cancer patients after radical surgery ( OR > 1), while robotic surgery were independent protective factors ( OR = 0.563). A column chart prediction model was established based on the risk factors affecting postoperative bladder spasms, and internal validation was performed using Bootstrap method with 1000 repeated samples. The predicted values of the calibration curve were basically consistent with the actual values, and the Hosmer Lemeshow goodness of fit test was performed χ 2 = 7.802, P = 0.453, the area under the ROC curve is 0.688 (95% CI : 0.626–0.750). Conclusions The occurrence of bladder spasms in prostate cancer patients after radical surgery is influenced by multiple factors, and the risk warning model established based on these factors has good predictive performance. prostate cancer radical prostatectomy bladder spasms risk factor Figures Figure 1 Figure 2 Introduction Prostate cancer is a prevalent malignant disease affecting male reproductive system cancers [ 1 ]. The incidence rate of prostate cancer in China has risen year after year as the population's aging rate has increased, as have lifestyle and eating habits [ 2 ]. With the ongoing advancement of early screening and diagnostic technology for prostate cancer, the majority of patients can now undergo curative surgical treatment at an early stage [ 3 ]. However, major surgery requires urethral restoration, and prolonged catheterization following surgery might easily result in bladder spasms. Bladder spasms can cause complications such as urine incontinence, bleeding, scar hyperplasia, and stenosis after extubation [ 4 ]. This can have a negative impact on patients' surgical outcomes and quality of life. Studies have revealed that bladder spasms post-surgery can be attributed to multiple factors, such as age, mental stress, and the speed of bladder flushing [ 5 – 6 ] .Currently, there are numerous studies on the factors that influence postoperative bladder spasms in patients with benign prostatic hyperplasia, but there is limited study on prostate cancer and no applicable prognostic models. Making tailored predictions remains a clinical problem. This work develops a column chart prediction model based on the risk factors influencing postoperative bladder spasms in prostate cancer in order to provide a specific guiding value for lowering the occurrence of postoperative bladder spasms and increasing patients' quality of life. The latest report is as follows. Materials and Methods Study design and inclusion criteria Oral and written information about the study were distributed to each participating patient. We collected informed written consent from each participant who did not object to the study. This study was approved by the Ethics Review Committee of the Army Military Medical University on September 22, 2024 (201904301). This retrospective study was conducted in three hospitals and identified patients who underwent radical prostatectomy for prostate cancer between January 2022 and January 2024. Inclusion criteria: 1) Patients whose diagnosis fits the criteria of the Chinese Expert Consensus on Early Diagnosis of Prostate Cancer, correctly diagnosed as prostate cancer without metastasis. 2) Patients having a radical prostatectomy for prostate cancer. 3) Patients with no distant metastases of the lesion; 4) The patient possesses certain communication, reading, and writing skills and is able to complete the survey questionnaire used in this study; and 5) The clinical data is complete. Exclusion criteria: 1) Patients with various urinary system disorders; 2) Patients with malignant tumors; 3) Patients with main organ malfunction; 4) Patients who have had surgical treatment in the lower abdomen and have skin disease or serious injury at the location of study implementation; 5) Concurrent mental disease and consciousness disorders. Diagnostic criteria for bladder spasm include conscious symptoms such as obvious bladder distension, urgent urge to urinate and defecate, along with spasmodic pain at the urethral opening and pubic area, characterized by paroxysms. Observable symptoms involve increased pressure in the bladder causing obstruction of urethral flushing fluid, leading to a backward flow of bladder fluid, resulting in deepening blood color. Patients are categorized into a bladder spasm group and a control group based on their experience of bladder spasms post-surgery. Research instrument A general information survey form is designed by researchers based on a literature review, expert consultation, and other methods. The form includes details such as patient age, surgical method, educational level, admission systolic blood pressure, medical history, prostate volume, pathological diagnosis, BMI, PSA, IPSS, SAS, surgical time, intraoperative blood loss, positive surgical margin, preoperative anxiety, catheter type, catheter balloon injection volume, postoperative constipation, pelvic floor muscle training, abdominal hot compress, and the occurrence of bladder spasms. The International Prostate Symptom Score (IPSS) assesses 7 urinary symptoms on a scale of 0–5 points and 6 levels, with higher scores indicating more severe symptoms. A total score of 0–35 points categorizes symptoms as mild (1–7 points), moderate (8–19 points), or severe (20–35 points). The Self Rating Anxiety Scale (SAS) classifies anxiety levels as mild (50–59), moderate (60–69), or severe (above 70). Survey method Clinical data from patients undergoing prostate cancer surgery is collected by trained researchers, with some data sourced from electronic medical records and telephone follow-up. A double check during data entry is necessary to maintain data accuracy. Statistical analysis The data were analyzed using SPSS 21.0 statistical software. Quantitative data that met normality were presented as mean ± standard deviation ( x ± s ) and analyzed using t-tests. Qualitative data were expressed as number of cases and percentage (%). Chi-square tests were performed with bladder spasms post-radiotherapy as the dependent variable and significant differences in univariate analysis as independent variables. Logistic regression was used to identify independent risk factors. A risk warning score model, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) for survival data were generated using RStudio 4.2.1. The Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to assess model consistency, with statistical significance set at p < 0.05 for model validation. Results Univariate analysis of bladder spasms after prostate cancer surgery In 281 patients with prostate cancer, the incidence of bladder spasms following radical prostatectomy was 46.30%. At admission, there were no statistically significant differences between the patients in the spasm group and the non-spasm group in terms of age, surgical time, prostate volume, BMI, intraoperative bleeding, positive surgical margin, TNM, urinary catheter model above 20, pelvic floor muscle exercise, or systolic blood pressure ( P > 0.05). The surgical methods, constipation, anxiety, fever, bladder bleeding, and bladder flushing speed of patients in the spasm group were compared with those in the non spasm group, and the differences were statistically significant ( P < 0.05) (Table 1 ). Table 1 Univariate analysis of bladder spasms in patients with prostate cancer after radical surgery Variable Bladder spasms ( n = 130) No-Bladder spasms ( n = 151) χ 2 /t p -value Age, (years) 67.99 ± 7.78 68.36 ± 6.87 -0.434 0.664 Robot surgery, (n%) 45 (34.62%) 76 (50.33%) 7.037 0.006 Operative time, (min) 181.99 ± 50.79 177.23 ± 50.70 0.784 0.434 Prostate volume, (ml) 35.07 ± 19.68 31.87 ± 16.16 1.476 0.141 BMI, (kg/m2) 24.67 ± 3.37 24.74 ± 3.48 -0.161 0.872 Intraoperative bleeding volume, (ml) 276.00 ± 164.51 267.55 ± 198.18 0.385 0.700 Positive surgical margin after surgery, (n%) 20 (15.38%) 29 (19.21%) 0.708 0.248 TNM, (n%) 1.916 0.384 T1 26 (20.00%) 35 (23.18%) T2 71 (54.61%) 70 (46.36%) T3 33 (25.39%) 46 (30.46%) Urinary catheter model, (≥ 20) 78 (60.00%) 97 (64.24%) 0.534 0.272 Preoperative pelvic floor muscle training, (n%) 80 (61.54%) 87 (57.62%) 0.446 0.293 Postoperative constipation, (n%) 49 (15.38%) 37 (19.21%) 5.722 0.012 SAS 54.78 ± 6.66 51.60 ± 8.09 3.606 <0.001 Systolic blood pressure upon admission, (mmHg) 136.38 ± 16.70 136.60 ± 17.29 -0.107 0.915 Postoperative temperature above 37.4, (n%) 54 (41.54%) 39 (25.83%) 7.787 0.004 Postoperative bladder bleeding, (n%) 12 (9.23%) 5 (3.31%) 4.307 0.034 Bladder flushing speed, (> 180 gtt/min) 55 (42.31%) 41 (27.15%) 7.134 0.005 Multivariate logistic regression analysis of bladder spasms after prostate cancer surgery Perform logistic regression analysis with bladder spasm in prostate cancer patients after radical surgery as the dependent variable and P 150 drops/min were independent risk factors for bladder spasms in prostate cancer patients after radical surgery ( OR > 1), while robotic surgery were independent protective factors ( OR = 0.563), as shown in Table 2 . Table 2 Multivariate Logistic regression analysis of bladder spasms in patients with prostate cancer after radical surgery Variable β SE waldχ2 P Value OR(%95CI) Robot surgery -0.574 0.264 4.727 0.030 0.563 (0.336–0.945) Prostate volume 0.010 0.007 1.801 0.180 1.010 (0.996–1.024) Postoperative constipation 0.430 0.283 2.316 0.128 1.537 (0.884–2.674) SAS 0.052 0.018 8.741 0.003 1.054 (1.018–1.091) Postoperative temperature above 37.4 0.723 0.277 6.835 0.009 2.060 (1.198–3.543) Postoperative bladder bleeding 1.014 0.590 2.956 0.086 2.758 (0.868–8.765) Bladder flushing speed, (> 150 d/min) 0.545 0.273 12.619 0.064 1.724 (1.010–2.945) Line chart of the risk warning score model for bladder spasms in prostate cancer patients after radical surgery Based on the four factors derived from logistic regression analysis, a risk prediction column chart for bladder spasms in prostate cancer patients following radical surgery was created using Rstudio 4.2.1, as shown in Fig. 1 . In clinical practice, when combined with patient data, the appropriate indicator score points are employed as vertical lines that stretch towards the "total score" standard scoring axis. The scores from each indication are totaled together, and a vertical line is drawn downward along the "risk probability" direction at the places on the total scoring axis. The calculated score represents the chance of bladder spasm in prostate cancer patients following aggressive surgery. Validation of a Column Chart Model for Predicting Postoperative Bladder Spasm in Prostate Cancer Patients Internal validation of the column chart model for predicting postoperative bladder spasms was performed using the Bootstrap method with 1000 repeated samples. The results showed that the calibration curve of the column chart model (Fig. 2 , a) was consistent with the actual values, and the Hosmer Lemeshow goodness of fit test was performed χ 2 = 7.802, P = 0.453. The area under the ROC curve was used to evaluate the discriminability of the column chart model for predicting postoperative bladder spasms. The area under the ROC curve was 0.688 (95%CI: 0.626–0.750). See Fig. 2 , b. The column chart model has good accuracy and discrimination in predicting postoperative bladder spasms in patients with prostate cancer. Discussion Patients who undergo radical surgery for prostate cancer have a longer survival rate [ 7 ], but it is important to minimize complications and enhance their quality of life. Bladder spasm, characterized by spasmodic contractions of the bladder smooth muscle or sphincter, is a common postoperative issue [ 8 ]. It can result in reduced patient tolerance, delayed wound healing, and in severe cases, bleeding, urinary leakage, and other symptoms, contributing to increased postoperative pain [ 9 ]. This study reveals that the occurrence of bladder spasms in patients following radical prostatectomy for prostate cancer is 46.30%, which is higher than the 26.67% reported by Liao [ 9 ] but lower than the 69.00% reported by Shen [ 10 ]. However, it can be deduced that the overall incidence of bladder spasms in patients undergoing radical prostatectomy is relatively high. Therefore, personalized prediction of postoperative bladder spasms and the implementation of targeted preventive measures are crucial for enhancing the quality of life for patients undergoing prostate cancer surgery. The findings of this research indicate that preoperative anxiety, elevated body temperature, and rapid bladder irrigation are independent risk factors for bladder spasms in prostate cancer patients post radical surgery ( P < 0.05), while robotic surgery serves as an independent protective factor ( P < 0.05). Anxiety has become a widespread social problem. Moderate to severe anxiety can significantly affect patient recovery [ 11 ]. Studies have shown that under anxious conditions, the patient's sympathetic nervous system tone is reduced, leading to a diminished inhibitory effect of the hypothalamic-pituitary-adrenal cortex system on the bladder detrusor muscle, resulting in increased bladder instability and spasms [ 12 ], patients with anxiety have weak willpower, decreased resistance, and reduced bearing capacity, lowering their pain threshold, and even a mild bladder irritation can cause strong reactions [ 13 ]. Anxiety patients overly concern themselves with their physical condition, excessively focus on their bladder, intensifying spasmodic pain experiences, and amplifying symptoms [ 14 ]. Postoperative fever in patients may be caused by urinary tract infections, which can increase the sensitivity of the urethral mucosa and the irritability of the bladder, leading to postoperative bladder spasms [ 15 ]. Therefore, it is necessary to manage and control the postoperative patient's body temperature. Effective bladder irrigation can prevent urinary tract blockage [ 16 ]. If the bladder flushing speed is too slow, it cannot achieve an effective flushing effect. If it is too fast, open bladder flushing with no adjustment speed for 20 minutes can increase the burden on the bladder, stimulate the sympathetic nervous system, increase the levels of catecholamines in the blood, and cause an increase in heart rate and blood pressure [ 17 ]. At the same time, it can stimulate the respiratory center reflexively, leading to accelerated breathing and an increase in hidden dangers for elderly patients with underlying cardiovascular and pulmonary diseases [ 18 ]. In clinical work, due to excessive bleeding two hours after surgery, doctors and nurses are more nervous, and the time for complete and rapid flushing is longer. In the early stage, we conducted evidence-based analysis and found that 180gtt/min is the critical value for bladder spasms in patients with benign prostatic hyperplasia [ 19 ]. Therefore, when conducting factor analysis, we also used this number of drops as the critical value. If the flushing speed is too fast, it will stimulate the parasympathetic nervous system in the bladder, causing a hypersensitivity reaction of the detrusor muscle to the meridian, leading to unstable bladder and bladder spasms [ 20 ]. Robot assisted laparoscopic radical prostatectomy for prostate cancer is the latest advancement in recent years for the treatment of prostate cancer. Surgical robots have a three-dimensional panoramic field of view, which can provide a magnified three-dimensional field of view up to 10 times, helping surgeons better identify anatomical landmarks such as the surrounding tissues of the prostate and the prostate cancer vascular system [ 21 ]. At the same time, the mechanical arm with stable and flexible instrument operation avoids the influence of physiological tremors by the surgeon, and the mechanical arm with 7 degrees of freedom is also more flexible, which can make the surgical anatomy more precise, reduce intraoperative bleeding, and reduce the occurrence of postoperative infections and bladder spasms [ 22 ]. This study developed a column chart prediction model to predict the probability of bladder spasm in prostate cancer patients by substituting values of specific indicators into the model formula. The obtained indicators are simple and the evaluation process is feasible. Quantitative models not only provide numerical predictions based on different risk factors but also help improve treatment effectiveness, prognosis, and quality of life for patients. Factors such as surgical methods, control of bladder irrigation fluid speed and postoperative body temperature, and psychological counseling can be selected based on factor analysis results to reduce the occurrence of postoperative bladder spasms. Limitations There are limitations in our study, including being a small sample size, requiring further research on sample size. Additionally, the model has not been externally validated due to limitations in research time and data collection. Therefore, the generalizability of the column chart prediction model for postoperative bladder spasms in prostate cancer requires further validation through multi center large sample. Conclusions The column chart prediction model, established based on risk factors affecting postoperative bladder spasms in prostate cancer, demonstrates good prediction accuracy and discrimination. This model can offer valuable guidance in preventing postoperative bladder spasms in patients undergoing prostate cancer surgery. Declarations Ethics approval and consent to participate: The protocol, case record form, and informed consent form were reviewed by the Ethics Committee of the Second Affiliated Hospital of Army Medical University. Written informed consent was obtained from all participants before enrolment. The study was conducted in accordance with principles of the Declaration of Helsinki. Confidentiality of all the data was maintained. Consent for publication: Consent for publication was obtained from all participants. Availability of data and materials: The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare no conflicts of interest or financial ties to disclose. Funding: This work was supported by the Top Young and Middle-aged Medical Talent of Chongqing, Top young and Middle-aged Medical Studio of Chongqing, Chongqing Science and Health Joint fund for top young and middle-aged talent (2023GDRc007), the Key Project for Clinical Innovation of Army Medical University (CX2019LC107)，the second Affiliated Hospital of Army Military Medical University Discipline Talent Construction Special Project (2023XKRC007). Author Contributions: Study design: Song Caiping, Zheng Ji Conceptualization and first author: Chen Yu Statistics: Chen Yu, Liao Chaoyu Data collection: Li Siyue, Zhou Luqiang, Guo Fang Review and editing: Song Caiping Acknowledgements: The authors warmly thank the patients who participated in this study. References Chang AJ, Autio KA, Roach M 3rd, Scher HI. High-risk prostate cancer-classification and therapy. Nat Rev Clin Oncol. 2014 Jun;11(6):308-23. doi: 10.1038/nrclinonc.2014.68. Wang G, Zhao D, Spring DJ, DePinho RA. 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Poelaert F, Joniau S, Roumeguère T, Ameye F, De Coster G, Dekuyper P, Quackels T, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Mottrie A, Lumen N; Belgian RALP Consortium. Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy. Eur Urol Oncol. 2019 Feb;2(1):110-117. doi: 10.1016/j.euo.2018.05.005. Gandaglia G, Montorsi F, Karakiewicz PI, Sun M. Robot-assisted radical prostatectomy in prostate cancer. Future Oncol. 2015;11(20):2767-73. doi: 10.2217/fon.15.169. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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surgery\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4521790/v1/2310546e4aa64df05ca11adf.png"},{"id":58760921,"identity":"03e40fd2-f05b-4e5d-82f6-9f156babad4c","added_by":"auto","created_at":"2024-06-20 18:52:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":108349,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Calibration curve for predicting postoperative bladder spasms, (b) ROC curve of the risk column chart model for bladder spasms in prostate cancer patients after radical surgery\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4521790/v1/0b1ccea697140f6752e784f5.png"},{"id":58760936,"identity":"10c1538a-d922-4d56-aa34-5e4ea45da5de","added_by":"auto","created_at":"2024-06-20 18:52:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":739149,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4521790/v1/6f24246e-e414-4a67-a7b4-9d530d7aeb9e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors for bladder spasms after radical prostatectomy for prostate cancer: A prospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer is a prevalent malignant disease affecting male reproductive system cancers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The incidence rate of prostate cancer in China has risen year after year as the population's aging rate has increased, as have lifestyle and eating habits [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With the ongoing advancement of early screening and diagnostic technology for prostate cancer, the majority of patients can now undergo curative surgical treatment at an early stage [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, major surgery requires urethral restoration, and prolonged catheterization following surgery might easily result in bladder spasms. Bladder spasms can cause complications such as urine incontinence, bleeding, scar hyperplasia, and stenosis after extubation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This can have a negative impact on patients' surgical outcomes and quality of life.\u003c/p\u003e \u003cp\u003eStudies have revealed that bladder spasms post-surgery can be attributed to multiple factors, such as age, mental stress, and the speed of bladder flushing [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] .Currently, there are numerous studies on the factors that influence postoperative bladder spasms in patients with benign prostatic hyperplasia, but there is limited study on prostate cancer and no applicable prognostic models. Making tailored predictions remains a clinical problem. This work develops a column chart prediction model based on the risk factors influencing postoperative bladder spasms in prostate cancer in order to provide a specific guiding value for lowering the occurrence of postoperative bladder spasms and increasing patients' quality of life. The latest report is as follows.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and inclusion criteria\u003c/h2\u003e \u003cp\u003e Oral and written information about the study were distributed to each participating patient. We collected informed written consent from each participant who did not object to the study. This study was approved by the Ethics Review Committee of the Army Military Medical University on September 22, 2024 (201904301). This retrospective study was conducted in three hospitals and identified patients who underwent radical prostatectomy for prostate cancer between January 2022 and January 2024.\u003c/p\u003e \u003cp\u003eInclusion criteria: 1) Patients whose diagnosis fits the criteria of the Chinese Expert Consensus on Early Diagnosis of Prostate Cancer, correctly diagnosed as prostate cancer without metastasis. 2) Patients having a radical prostatectomy for prostate cancer. 3) Patients with no distant metastases of the lesion; 4) The patient possesses certain communication, reading, and writing skills and is able to complete the survey questionnaire used in this study; and 5) The clinical data is complete. Exclusion criteria: 1) Patients with various urinary system disorders; 2) Patients with malignant tumors; 3) Patients with main organ malfunction; 4) Patients who have had surgical treatment in the lower abdomen and have skin disease or serious injury at the location of study implementation; 5) Concurrent mental disease and consciousness disorders. Diagnostic criteria for bladder spasm include conscious symptoms such as obvious bladder distension, urgent urge to urinate and defecate, along with spasmodic pain at the urethral opening and pubic area, characterized by paroxysms. Observable symptoms involve increased pressure in the bladder causing obstruction of urethral flushing fluid, leading to a backward flow of bladder fluid, resulting in deepening blood color. Patients are categorized into a bladder spasm group and a control group based on their experience of bladder spasms post-surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eResearch instrument\u003c/h2\u003e \u003cp\u003eA general information survey form is designed by researchers based on a literature review, expert consultation, and other methods. The form includes details such as patient age, surgical method, educational level, admission systolic blood pressure, medical history, prostate volume, pathological diagnosis, BMI, PSA, IPSS, SAS, surgical time, intraoperative blood loss, positive surgical margin, preoperative anxiety, catheter type, catheter balloon injection volume, postoperative constipation, pelvic floor muscle training, abdominal hot compress, and the occurrence of bladder spasms. The International Prostate Symptom Score (IPSS) assesses 7 urinary symptoms on a scale of 0\u0026ndash;5 points and 6 levels, with higher scores indicating more severe symptoms. A total score of 0\u0026ndash;35 points categorizes symptoms as mild (1\u0026ndash;7 points), moderate (8\u0026ndash;19 points), or severe (20\u0026ndash;35 points). The Self Rating Anxiety Scale (SAS) classifies anxiety levels as mild (50\u0026ndash;59), moderate (60\u0026ndash;69), or severe (above 70).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey method\u003c/h3\u003e\n\u003cp\u003eClinical data from patients undergoing prostate cancer surgery is collected by trained researchers, with some data sourced from electronic medical records and telephone follow-up. A double check during data entry is necessary to maintain data accuracy.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using SPSS 21.0 statistical software. Quantitative data that met normality were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e) and analyzed using t-tests. Qualitative data were expressed as number of cases and percentage (%). Chi-square tests were performed with bladder spasms post-radiotherapy as the dependent variable and significant differences in univariate analysis as independent variables. Logistic regression was used to identify independent risk factors. A risk warning score model, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) for survival data were generated using RStudio 4.2.1. The Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to assess model consistency, with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for model validation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate analysis of bladder spasms after prostate cancer surgery\u003c/h2\u003e \u003cp\u003eIn 281 patients with prostate cancer, the incidence of bladder spasms following radical prostatectomy was 46.30%. At admission, there were no statistically significant differences between the patients in the spasm group and the non-spasm group in terms of age, surgical time, prostate volume, BMI, intraoperative bleeding, positive surgical margin, TNM, urinary catheter model above 20, pelvic floor muscle exercise, or systolic blood pressure (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The surgical methods, constipation, anxiety, fever, bladder bleeding, and bladder flushing speed of patients in the spasm group were compared with those in the non spasm group, and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of bladder spasms in patients with prostate cancer after radical surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBladder spasms\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo-Bladder spasms\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.99\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobot surgery, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (34.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (50.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181.99\u0026thinsp;\u0026plusmn;\u0026thinsp;50.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177.23\u0026thinsp;\u0026plusmn;\u0026thinsp;50.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate volume, (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.07\u0026thinsp;\u0026plusmn;\u0026thinsp;19.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.87\u0026thinsp;\u0026plusmn;\u0026thinsp;16.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, (kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative bleeding volume, (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e276.00\u0026thinsp;\u0026plusmn;\u0026thinsp;164.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267.55 \u0026plusmn; 198.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive surgical margin after surgery, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (15.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (19.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (20.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (23.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (54.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (46.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (25.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (30.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary catheter model, (\u0026ge;\u0026thinsp;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (60.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (64.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative pelvic floor muscle training, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (61.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (57.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative constipation, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (15.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (19.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure upon admission, (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136.38\u0026thinsp;\u0026plusmn;\u0026thinsp;16.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136.60\u0026thinsp;\u0026plusmn;\u0026thinsp;17.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative temperature above 37.4, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (41.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (25.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative bladder bleeding, (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (9.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (3.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder flushing speed, (\u0026gt; 180 gtt/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (42.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (27.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate logistic regression analysis of bladder spasms after prostate cancer surgery\u003c/h2\u003e \u003cp\u003ePerform logistic regression analysis with bladder spasm in prostate cancer patients after radical surgery as the dependent variable and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.2 as the independent variable in univariate analysis. The results showed that preoperative anxiety, postoperative body temperature above 37.4, and flushing fluid speed\u0026thinsp;\u0026gt;\u0026thinsp;150 drops/min were independent risk factors for bladder spasms in prostate cancer patients after radical surgery (\u003cem\u003eOR\u003c/em\u003e \u0026gt; 1), while robotic surgery were independent protective factors (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.563), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic regression analysis of bladder spasms in patients with prostate cancer after radical surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ewaldχ2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR(%95CI)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobot surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.563 (0.336\u0026ndash;0.945)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.010 (0.996\u0026ndash;1.024)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative constipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.537 (0.884\u0026ndash;2.674)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.054 (1.018\u0026ndash;1.091)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative temperature above 37.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.060 (1.198\u0026ndash;3.543)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative bladder bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.758 (0.868\u0026ndash;8.765)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder flushing speed, (\u0026gt; 150 d/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.064\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.724 (1.010\u0026ndash;2.945)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLine chart of the risk warning score model for bladder spasms in prostate cancer patients after radical surgery\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on the four factors derived from logistic regression analysis, a risk prediction column chart for bladder spasms in prostate cancer patients following radical surgery was created using Rstudio 4.2.1, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In clinical practice, when combined with patient data, the appropriate indicator score points are employed as vertical lines that stretch towards the \"total score\" standard scoring axis. The scores from each indication are totaled together, and a vertical line is drawn downward along the \"risk probability\" direction at the places on the total scoring axis. The calculated score represents the chance of bladder spasm in prostate cancer patients following aggressive surgery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eValidation of a Column Chart Model for Predicting Postoperative Bladder Spasm in Prostate Cancer Patients\u003c/h2\u003e \u003cp\u003eInternal validation of the column chart model for predicting postoperative bladder spasms was performed using the Bootstrap method with 1000 repeated samples. The results showed that the calibration curve of the column chart model (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, a) was consistent with the actual values, and the Hosmer Lemeshow goodness of fit test was performed \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.802, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.453. The area under the ROC curve was used to evaluate the discriminability of the column chart model for predicting postoperative bladder spasms. The area under the ROC curve was 0.688 (95%CI: 0.626\u0026ndash;0.750). See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, b. The column chart model has good accuracy and discrimination in predicting postoperative bladder spasms in patients with prostate cancer.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients who undergo radical surgery for prostate cancer have a longer survival rate [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], but it is important to minimize complications and enhance their quality of life. Bladder spasm, characterized by spasmodic contractions of the bladder smooth muscle or sphincter, is a common postoperative issue [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It can result in reduced patient tolerance, delayed wound healing, and in severe cases, bleeding, urinary leakage, and other symptoms, contributing to increased postoperative pain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This study reveals that the occurrence of bladder spasms in patients following radical prostatectomy for prostate cancer is 46.30%, which is higher than the 26.67% reported by Liao [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] but lower than the 69.00% reported by Shen [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, it can be deduced that the overall incidence of bladder spasms in patients undergoing radical prostatectomy is relatively high. Therefore, personalized prediction of postoperative bladder spasms and the implementation of targeted preventive measures are crucial for enhancing the quality of life for patients undergoing prostate cancer surgery.\u003c/p\u003e \u003cp\u003eThe findings of this research indicate that preoperative anxiety, elevated body temperature, and rapid bladder irrigation are independent risk factors for bladder spasms in prostate cancer patients post radical surgery (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while robotic surgery serves as an independent protective factor (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Anxiety has become a widespread social problem. Moderate to severe anxiety can significantly affect patient recovery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies have shown that under anxious conditions, the patient's sympathetic nervous system tone is reduced, leading to a diminished inhibitory effect of the hypothalamic-pituitary-adrenal cortex system on the bladder detrusor muscle, resulting in increased bladder instability and spasms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], patients with anxiety have weak willpower, decreased resistance, and reduced bearing capacity, lowering their pain threshold, and even a mild bladder irritation can cause strong reactions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Anxiety patients overly concern themselves with their physical condition, excessively focus on their bladder, intensifying spasmodic pain experiences, and amplifying symptoms [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Postoperative fever in patients may be caused by urinary tract infections, which can increase the sensitivity of the urethral mucosa and the irritability of the bladder, leading to postoperative bladder spasms [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, it is necessary to manage and control the postoperative patient's body temperature.\u003c/p\u003e \u003cp\u003eEffective bladder irrigation can prevent urinary tract blockage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. If the bladder flushing speed is too slow, it cannot achieve an effective flushing effect. If it is too fast, open bladder flushing with no adjustment speed for 20 minutes can increase the burden on the bladder, stimulate the sympathetic nervous system, increase the levels of catecholamines in the blood, and cause an increase in heart rate and blood pressure [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. At the same time, it can stimulate the respiratory center reflexively, leading to accelerated breathing and an increase in hidden dangers for elderly patients with underlying cardiovascular and pulmonary diseases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In clinical work, due to excessive bleeding two hours after surgery, doctors and nurses are more nervous, and the time for complete and rapid flushing is longer. In the early stage, we conducted evidence-based analysis and found that 180gtt/min is the critical value for bladder spasms in patients with benign prostatic hyperplasia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, when conducting factor analysis, we also used this number of drops as the critical value. If the flushing speed is too fast, it will stimulate the parasympathetic nervous system in the bladder, causing a hypersensitivity reaction of the detrusor muscle to the meridian, leading to unstable bladder and bladder spasms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Robot assisted laparoscopic radical prostatectomy for prostate cancer is the latest advancement in recent years for the treatment of prostate cancer. Surgical robots have a three-dimensional panoramic field of view, which can provide a magnified three-dimensional field of view up to 10 times, helping surgeons better identify anatomical landmarks such as the surrounding tissues of the prostate and the prostate cancer vascular system [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. At the same time, the mechanical arm with stable and flexible instrument operation avoids the influence of physiological tremors by the surgeon, and the mechanical arm with 7 degrees of freedom is also more flexible, which can make the surgical anatomy more precise, reduce intraoperative bleeding, and reduce the occurrence of postoperative infections and bladder spasms [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study developed a column chart prediction model to predict the probability of bladder spasm in prostate cancer patients by substituting values of specific indicators into the model formula. The obtained indicators are simple and the evaluation process is feasible. Quantitative models not only provide numerical predictions based on different risk factors but also help improve treatment effectiveness, prognosis, and quality of life for patients. Factors such as surgical methods, control of bladder irrigation fluid speed and postoperative body temperature, and psychological counseling can be selected based on factor analysis results to reduce the occurrence of postoperative bladder spasms.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThere are limitations in our study, including being a small sample size, requiring further research on sample size. Additionally, the model has not been externally validated due to limitations in research time and data collection. Therefore, the generalizability of the column chart prediction model for postoperative bladder spasms in prostate cancer requires further validation through multi center large sample.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe column chart prediction model, established based on risk factors affecting postoperative bladder spasms in prostate cancer, demonstrates good prediction accuracy and discrimination. This model can offer valuable guidance in preventing postoperative bladder spasms in patients undergoing prostate cancer surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The protocol, case record form, and informed consent form were reviewed by the Ethics Committee of the Second Affiliated Hospital of Army Medical University. Written informed consent was obtained from all participants before enrolment. The study was conducted in accordance with principles of the Declaration of Helsinki. Confidentiality of all the data was maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Consent for publication was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no conflicts of interest or financial ties to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by the Top Young and Middle-aged Medical Talent of Chongqing, Top young and Middle-aged Medical Studio of Chongqing, Chongqing Science and Health Joint fund for top young and middle-aged talent (2023GDRc007), the Key Project for Clinical Innovation of Army Medical University (CX2019LC107)，the second Affiliated Hospital of Army Military Medical University Discipline Talent Construction Special Project (2023XKRC007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design:\u0026nbsp;Song Caiping,\u0026nbsp;Zheng\u0026nbsp;Ji\u003c/p\u003e\n\u003cp\u003eConceptualization\u0026nbsp;and first author: Chen Yu\u003c/p\u003e\n\u003cp\u003eStatistics:\u0026nbsp;Chen Yu, Liao Chaoyu\u003c/p\u003e\n\u003cp\u003eData collection:\u0026nbsp;Li Siyue, Zhou Luqiang, Guo Fang\u003c/p\u003e\n\u003cp\u003eReview and editing:\u0026nbsp;Song Caiping\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors warmly thank the patients who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChang AJ, Autio KA, Roach M 3rd, Scher HI. High-risk prostate cancer-classification and therapy. Nat Rev Clin Oncol. 2014 Jun;11(6):308-23. doi: 10.1038/nrclinonc.2014.68.\u003c/li\u003e\n\u003cli\u003eWang G, Zhao D, Spring DJ, DePinho RA. Genetics and biology of prostate cancer. Genes Dev. 2018 Sep 1;32(17-18):1105-1140. doi: 10.1101/gad.315739.118. \u003c/li\u003e\n\u003cli\u003ePinsky PF, Parnes H. Screening for Prostate Cancer. N Engl J Med. 2023 Apr 13;388(15):1405-1414. doi: 10.1056/NEJMcp2209151. \u003c/li\u003e\n\u003cli\u003eDeljou A, Soleimani J, Olive EJ, McLaren RH, Schroeder DR, Sprung J, Weingarten TN. Bladder spasms following ambulatory urologic procedures. Can J Urol. 2022 Jun;29(3):11175-11181. \u003c/li\u003e\n\u003cli\u003eZhang C, Xiao Z, Zhang X, Guo L, Sun W, Tai C, Jiang Z, Liu Y. Transcutaneous electrical stimulation of somatic afferent nerves in the foot relieved symptoms related to postoperative bladder spasms. BMC Urol. 2017 Jul 13;17(1):58. doi: 10.1186/s12894-017-0248-9. \u003c/li\u003e\n\u003cli\u003eTaratkin M, Shpikina A, Morozov A, Novikov A, Fokin I, Petov V, Herrmann TR, Misrai V, Lusuardi L, Teoh JY, McFarland J, Kozlov V, Enikeev D. Enucleation vs. vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis. Minerva Urol Nephrol. 2022 Oct;74(5):559-569. doi: 10.23736/S2724-6051.21.04639-5. \u003c/li\u003e\n\u003cli\u003eThoma C. Prostate cancer: Quality of life during chemohormonal therapy. Nat Rev Urol. 2018 May;15(5):263. doi: 10.1038/nrurol.2018.44. \u003c/li\u003e\n\u003cli\u003eDe E, Gomery P, Rosenberg LB. Palliation of Bladder Spasms #337. J Palliat Med. 2017 Oct;20(10):1158-1159. doi: 10.1089/jpm.2017.0353. \u003c/li\u003e\n\u003cli\u003eLiao XH, Wu JH, Zeng QP, et al. Construction and validation of a risk prediction model for bladder spasms after radical prostatectomy for prostate cancer [J]. Nursing Research, 2023 (24): 4408-4412\u003c/li\u003e\n\u003cli\u003eShen JK, Chan KG, Warner JN. Continent cutaneous ileocecal cystoplasty in the treatment of refractory bladder neck contracture and urinary incontinence after prostate cancer treatment. Can J Urol. 2020 Feb;27(1):10093-10098. \u003c/li\u003e\n\u003cli\u003eLeichsenring F, Heim N, Steinert C. A Review of Anxiety Disorders. JAMA. 2023 Apr 18;329(15):1315-1316. doi: 10.1001/jama.2023.2428. \u003c/li\u003e\n\u003cli\u003eWong CL, Choi KC. Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture: A Randomized Clinical Trial. JAMA Netw Open. 2023 Feb 1;6(2):e230001. doi: 10.1001/jamanetworkopen.2023.0001. \u003c/li\u003e\n\u003cli\u003eCorder G, Ahanonu B, Grewe BF, Wang D, Schnitzer MJ, Scherrer G. An amygdalar neural ensemble that encodes the unpleasantness of pain. Science. 2019 Jan 18;363(6424):276-281. doi: 10.1126/science.aap8586. \u003c/li\u003e\n\u003cli\u003eGoyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018. \u003c/li\u003e\n\u003cli\u003eKehlet H. Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored. Pain. 2018 Sep;159 Suppl 1:S11-S16. doi: 10.1097/j.pain.0000000000001243. \u003c/li\u003e\n\u003cli\u003eYang B, Han J. Analysis of flow rate of continuous bladder irrigation according to the height of the irrigation infusion set. Sci Rep. 2023 Nov 12;13(1):19715. doi: 10.1038/s41598-023-47198-2. \u003c/li\u003e\n\u003cli\u003eElliott TS, Reid L, Rao GG, Rigby RC, Woodhouse K. Bladder irrigation or irritation? Br J Urol. 1989 Oct;64(4):391-4. doi: 10.1111/j.1464-410x.1989.tb06049.x. \u003c/li\u003e\n\u003cli\u003eFok KH, Shaikh S, Jayatunga R, Malik S, Lee J, Carrillo B, Farcas M. An Autonomous Continuous Bladder Irrigation System. J Endourol. 2023 Sep;37(9):1063-1069. doi: 10.1089/end.2023.0177. \u003c/li\u003e\n\u003cli\u003eSun Ting, Chen Qingli, Yuan Hui, et al. Study on the optimal flushing speed for continuous bladder irrigation [J]. Journal of Practical Clinical Medicine, 2021, 025 (014): 90-93.\u003c/li\u003e\n\u003cli\u003eNott MR, Jameson PM, Julious SA. Diazepam for relief of irrigation pain after transurethral resection of the prostate. Eur J Anaesthesiol. 1997 Mar;14(2):197-200. doi: 10.1046/j.1365-2346.1997.00102.x. \u003c/li\u003e\n\u003cli\u003ePoelaert F, Joniau S, Roumegu\u0026egrave;re T, Ameye F, De Coster G, Dekuyper P, Quackels T, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Mottrie A, Lumen N; Belgian RALP Consortium. Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy. Eur Urol Oncol. 2019 Feb;2(1):110-117. doi: 10.1016/j.euo.2018.05.005.\u003c/li\u003e\n\u003cli\u003eGandaglia G, Montorsi F, Karakiewicz PI, Sun M. Robot-assisted radical prostatectomy in prostate cancer. Future Oncol. 2015;11(20):2767-73. doi: 10.2217/fon.15.169. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"prostate cancer, radical prostatectomy, bladder spasms, risk factor","lastPublishedDoi":"10.21203/rs.3.rs-4521790/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4521790/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative bladder spasms in prostate cancer patients have the potential to significantly impact their quality of life following surgery. It is essential to investigate the risk factors associated with bladder spasms in this patient population post-radical surgery to develop effective prevention strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective selection was conducted on 281 patients who underwent radical prostatectomy in our hospital from March 2022 to March 2024. They were divided into two groups based on whether bladder spasms occurred after surgery: the occurrence group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;130) and the non occurrence group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;151). Logistic regression analysis was performed on possible related factors to construct a column chart risk model. Another 43 prostate cancer patients who underwent radical surgery were selected to validate the model.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results of multivariate logistic regression analysis showed that preoperative anxiety, postoperative body temperature above 37.4, and flushing fluid speed\u0026thinsp;\u0026gt;\u0026thinsp;150 drops/min were independent risk factors for bladder spasms in prostate cancer patients after radical surgery (\u003cem\u003eOR\u003c/em\u003e \u0026gt; 1), while robotic surgery were independent protective factors (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.563). A column chart prediction model was established based on the risk factors affecting postoperative bladder spasms, and internal validation was performed using Bootstrap method with 1000 repeated samples. The predicted values of the calibration curve were basically consistent with the actual values, and the Hosmer Lemeshow goodness of fit test was performed χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.802, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.453, the area under the ROC curve is 0.688 (95%\u003cem\u003eCI\u003c/em\u003e: 0.626\u0026ndash;0.750).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe occurrence of bladder spasms in prostate cancer patients after radical surgery is influenced by multiple factors, and the risk warning model established based on these factors has good predictive performance.\u003c/p\u003e","manuscriptTitle":"Risk factors for bladder spasms after radical prostatectomy for prostate cancer: A prospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 18:51:51","doi":"10.21203/rs.3.rs-4521790/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78251919-760a-483a-9a0e-e7ad4724a78e","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-10T13:29:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-20 18:51:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4521790","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4521790","identity":"rs-4521790","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}