Analysis of Predictive Factors for Return to Sports in Female Athletes With Stress Urinary Incontinence

Abstract

Introduction This study aimed to identify predictive factors for successful return to sports among elite female athletes (EFAs) experiencing stress urinary incontinence (SUI). We used machine learning to analyze these predictors. Methods This study was conducted at Yokosuka Urogynecology and Urology Clinic, located in Yokosuka City, Kanagawa, Japan. A total of 153 EFAs with postpartum SUI were included in this retrospective cohort study. Information regarding the frequency of pelvic floor muscle training (PFMT), treatment approaches, rates of return to sports after one year, and one-hour pad test (1HrPadtest) at three months were collected. Results At three months, 26.8% of the EFAs improved in SUI; after one year, 28.1% returned to their respective sports successfully. The equation for predicting return to sports (logit(p)) involved several factors: (a) serum total testosterone, (b) PFMT frequency per week, (c) 1HrPadtest at three months, and (d) vaginal erbium-doped yttrium aluminum garnet laser (VEL) + urethral EL (UEL) treatment. The equation was as follows: -126 - 0.07276a + 25.98b - 1.947c - 25.32d, with a logit(p) cutoff point at 0.5. The optimal cutoff values and the four influential factors were determined through a receiver operating characteristic (ROC) analysis and the random forest model, respectively. Conclusions For EFAs with severe SUI to successfully return to their sports activities, the PFMT frequency was paramount. Patients who exhibited unsatisfactory results in the 1HrPadtest at the three-month mark benefited from the VEL+UEL treatment. Serum total testosterone proved to be an effective discerning criterion.

Keywords: ai and robotics in healthcare; chatgpt; elite female athletes; pelvic floor muscle training; serum total testosterone; stress urinary incontinence; urethral erbium laser for urinary incontinence; vaginal erbium laser for urinary incontinance.

Figure 1. ROC analysis and cutoff values

(a) ROC curve for the relationship between serum total testosterone and return-to-sport rates. (b) ROC curve for the cutoff value of PFMT frequency per week and return-to-sport rates. (c) ROC curve for the cutoff value of the 1HrPadtest at three months and return-to-sport rates. In each figure, specificity is plotted on the X-axis ranging from 1.0 to 0.0, and sensitivity is plotted on the Y-axis ranging from 0.0 to 1.0. The AUC (confidence interval) for Figure 1a is 44.000 (0.955, 0.837), for Figure 1b is 7.000 (1.000, 0.791), and for Figure 1c is 18.000 (0.936, 1.000). 1HrPadtest: 1-hour pad test, AUC: area under the curve, PFMT: pelvic floor muscle training, ROC: receiver operating characteristic

Figure 2. Random forest variable importance

The vertical axis represents the importance of variables when the target variable is set as "return rates at one year" in the random forest model. The horizontal axis represents the variables, with the following corresponding labels: (a) 1HrPadtest at three months, (b) total testosterone levels, (c) VEL+UEL treatment, and (d) frequency of PFMT per week. 1HrPadtest: 1-hour pad test, PFMT: pelvic floor muscle training, VEL+UEL: vaginal erbium-doped yttrium aluminum garnet laser and urethral erbium-doped yttrium aluminum garnet laser