Abstract
PURPOSE: This study aims to identify independent risk factors for mixed urinary incontinence (MUI) in parous women using a multicenter epidemiological study and to establish and validate a predictive nomogram. METHODS: A large-scale survey was conducted from June 2022 to September 2023, including parous women aged over 20 selected through stratified random sampling. Data encompassed sociodemographic and obstetric histories, comorbidities, and standardized questionnaires. The primary goal was to identify high-risk factors for MUI, while the secondary was to develop a nomogram. Risk factors were determined using univariable and multivariable analyses. The nomogram's performance was assessed via concordance index (C-index) and calibration plots through internal and external validation. RESULTS: A total of 7709 women participated, with an MUI prevalence of 6.8%. Independent risk factors included higher body mass index, urban residence, postmenopausal status, multiple vaginal deliveries, history of pelvic surgery and macrosomia, family history of pelvic floor dysfunction, hypertension, and constipation. The area under the curve for the nomogram model was 0.717 in the training set, 0.714 for internal validation, and 0.725 for external validation. The calibration plots showed a good agreement between the predicted and observed outcomes. CONCLUSION: This study identifies key risk factors for MUI in parous women and introduces a validated nomogram with high but not perfect predictive accuracy. The model enables early identification and management of MUI, though further refinement could enhance accuracy.