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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 646-655. doi: 10.19723/j.issn.1671-167X.2024.04.017

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Construction of a predictive model for postoperative pain relief after microscopic spermatic cord surgery for spermatic cord pain

Hailong HE,Qing LI,Tao XU,Xiaowei ZHANG*()   

  1. Department of Urology, Peking University People' s Hospital; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
  • Received:2024-03-12 Online:2024-08-18 Published:2024-07-23
  • Contact: Xiaowei ZHANG E-mail:docachang@126.com
  • Supported by:
    the Beijing Natural Science Foundation(7194327)

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Abstract:

Objective: To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief. Methods: A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023. This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic spermatic cord pain. All the patients underwent microsurgical procedures: varicocele-related pain was treated with microsurgical varicocelectomy, and idiopathic pain was treated with microsurgical denervation of the spermatic cord. The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50% six months post-surgery compared with pre-surgery levels. Baseline data were preliminarily screened for clinical indicators using t tests and univariate analysis. Clinical predictor variables [age, duration of pain, diameter of varicocele, patient health questionnaire-9 (PHQ-9) score, generalized anxiety disorder-7 (GAD-7) score] were selected using Lasso regression. A clinical prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram. The model's internal validation was performed using the bootstrap method. Its predictive power and clinical utility were evaluated through the concor-dance index, the area under the receiver operating characteristic curve, and calibration plots. Results: Post-microscopic varicocele ligation, 156 patients (73.58%) experienced significant pain relief, as did 94 patients (83.93%) following microscopic denervation. Independent predictors for postoperative outcomes included age, PHQ-9 score, GAD-7 score, chronic pain duration, and varicocele diameter, differing slightly between varicocele-related and idiopathic pain groups. The models demonstrated excellent predictive ability, with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups, respectively, and high concordance indices. Conclusion: The postoperative efficacy prediction model based on age, pain duration, PHQ-9 score, GAD-7 score, and varicocele diameter has good predictive ability and clinical applicability, and can be used in clinical practice.

Key words: Spermatic cord, Pain, Varicocele, Denervation, Predictive model

CLC Number: 

  • R697.24

Figure 1

Lasso regression coefficient penalty plot for the varicocele-related spermatic cord pain group"

Table 1

Multivariate analysis results of factors influencing pain relief after microscopic varicocele ligation"

Influencing factors Regression coefficient Standard error Z P OR OR (95%CI)
Age/years 0.078 0.024 3.240 0.001 1.081 1.033-1.137
Pain course time/months 0.071 0.022 3.080 0.002 1.070 1.029-1.127
PHQ-9 -0.100 0.080 -1.229 0.040 0.906 0.768-1.048
GAD-7 -0.275 0.092 -2.990 0.003 0.759 0.627-0.900
Varicocele vein diameter/mm -1.897 0.346 -5.476 < 0.001 0.150 0.072-0.282
Intercept 3.875 1.415 2.737 0.006 48.175 3.331-894.121

Figure 2

Lasso regression coefficient penalty plot for the idiopathic spermatic cord pain group"

Table 2

Multivariate analysis results of factors influencing pain relief after microscopic denervation of the spermatic cord"

Influencing factors Regression coefficient Standard error Z P OR OR (95%CI)
Age/years 0.088 0.030 2.932 0.003 1.092 1.033-1.163
Pain course time/months -0.078 0.026 -3.039 0.002 0.925 0.876-0.971
PHQ-9 -0.178 0.074 -2.418 0.016 0.837 0.717-0.959
GAD-7 -0.242 0.090 -2.700 0.007 0.785 0.648-0.922
Intercept 2.829 1.508 1.876 0.061 16.930 1.025-420.954

Figure 3

Nomogram model for the patients with varicocele-related spermatic cord pain PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Figure 4

Nomogram model for the patients with idiopathic spermatic cord pain PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Table 3

Evaluation of the predictive model's efficacy for varicocele-related spermatic cord pain (n=212)"

Influencing factors AUC value Sensitivity Specificity Youden index Cut off
Prediction model 0.909 0.882 0.833 0.715 0.645
Age/years 0.684 0.546 0.900 0.446 46.000
Time of pain course/months 0.723 0.849 0.550 0.399 17.000
PHQ-9 0.702 0.683 0.658 0.341 5.000
Varicocele vein diameter/mm 0.769 0.783 0.678 0.461 3.000
GAD-7 0.763 0.867 0.612 0.479 4.000

Figure 5

ROC of the predictive model for varicocele-related spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic."

Figure 6

Individual ROC for each factor of the predictive model for varicocele-related spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic; PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Table 4

Evaluation of the predictive model's efficacy for idiopathic spermatic cord pain (n=112)"

Influencing factors AUC value Sensitivity Specificity Youden index Cut off
Prediction model 0.913 0.863 0.906 0.769 0.734
Age/years 0.772 0.650 0.844 0.494 43.000
Pain course time/months 0.794 0.844 0.600 0.444 24.000
PHQ-9 0.850 0.906 0.625 0.531 6.000
GAD-7 0.738 0.813 0.713 0.525 7.000

Figure 7

ROC of the predictive model for idiopathic spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic."

Figure 8

Individual ROC for each factor in the predictive model for idiopathic spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic; PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

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