Risk factors and development of a nomogram prediction model for urinary dysfunction after laparoscopic radical surgery for rectal cancer

Abstract

Background Urinary dysfunction is a relatively common functional complication after laparoscopic radical surgery for rectal cancer and may affect postoperative recovery and quality of life. This study aimed to identify risk factors for urinary dysfunction after laparoscopic radical rectal cancer surgery and to develop a nomogram prediction model to facilitate early identification of high-risk patients. Methods A total of 392 patients who underwent laparoscopic radical surgery for rectal cancer between January 2021 and December 2025 were retrospectively included. Patients were grouped according to the occurrence of postoperative urinary dysfunction and randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Demographic, tumor-related, and perioperative variables were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors, and a nomogram model was constructed. Model performance was evaluated using receiver operating characteristic curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis. Results Among the 392 patients, 84 developed postoperative urinary dysfunction, with an incidence of 21.4%. Multivariable logistic regression analysis showed that age ≥65 years, male sex, tumor distance from the anal verge ≤5 cm, intraoperative fluid rate ≥10 mL/kg/h, neoadjuvant chemoradiotherapy, documented incomplete pelvic autonomic nerve preservation, and postoperative urinary tract infection were independent factors associated with postoperative urinary dysfunction. A nomogram was constructed based on these predictors. The area under the curve was 0.864 (95% CI: 0.803–0.926) in the training cohort and 0.856 (95% CI: 0.774–0.938) in the validation cohort. Calibration curves and the Hosmer-Lemeshow test indicated good model fit, and decision curve analysis showed favorable clinical net benefit. Conclusion Age, sex, tumor distance from the anal verge, intraoperative fluid rate, neoadjuvant chemoradiotherapy, pelvic autonomic nerve preservation, and postoperative urinary tract infection were closely associated with urinary dysfunction after laparoscopic radical surgery for rectal cancer. The nomogram based on these factors showed good predictive performance and may help identify high-risk patients, guide urinary catheter management, and support postoperative follow-up.