A Prospective Patient-centred Evaluation of Urethroplasty for Anterior Urethral Stricture Using a Validated Patient-reported Outcome Measure

• Published in: European urology Vol. 64; no. 5; pp. 777 - 782
• Main Authors: Jackson, Matthew J, Chaudhury, Ishaan, Mangera, Altaf, Brett, Andrew, Watkin, Nick, Chapple, Christopher R, Andrich, Daniela E, Pickard, Robert S, Mundy, Anthony R
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01-11-2013; Elsevier
• Subjects: Adolescent; Adult; Aged; Benchmarking; Biological and medical sciences; Health Status; Humans; Lower Urinary Tract Symptoms - etiology; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Outcome assessment (health care); Patient Satisfaction; Patient-reported outcome measure; Predictive Value of Tests; Prospective Studies; Psychometrics; Quality Indicators, Health Care; Quality of life; Reproducibility of Results; Surveys and Questionnaires; Time Factors; Treatment Outcome; United Kingdom; Urethral stricture; Urethral Stricture - complications; Urethral Stricture - diagnosis; Urethral Stricture - surgery; Urethral surgery; Urethroplasty; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures - adverse effects; Urology; Young Adult; Urethral stricture; Outcome assessment (health care); Patient-reported outcome measure; Quality of life; Urethral surgery; Urethroplasty; Nephrology; Urethral disease; Prognosis; Anterior; Urology; Prospective; Urethra; Surgery; Quantitative analysis; Human; Evaluation; Urinary system disease; Health; Urinary tract disease; Care; Case study; Plasty; Treatment; Urethral stenosis
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2013.04.037

Abstract Background Studies of interventions for urethral stricture have inferred patient benefit from clinician-driven outcomes or questionnaires lacking scientifically robust evidence of their measurement properties for men with this disease. Objective To evaluate urethral reconstruction from the patients’ perspective using a validated patient-reported outcome measure (PROM). Design, setting, and participants Forty-six men with anterior urethral stricture at four UK urology centres completed the PROM before (baseline) and 2 yr after urethroplasty. Intervention A psychometrically robust PROM for men with urethral stricture disease. Outcome measurements and statistical analysis Lower urinary tract symptoms (LUTS), health status, and treatment satisfaction were measured, and paired t and Wilcoxon matched-pairs tests were used for comparative analysis. Results and limitations Thirty-eight men underwent urethroplasty for bulbar stricture and eight for penile stricture. The median (range) follow-up was 25 (20–30) mo. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) improved from a median of 12 at baseline to 4 at 2 yr (mean [95% confidence interval (CI)] of differences 6.6 [4.2–9.1], p < 0.0001). A total of 33 men (72%) felt their urinary symptoms interfered less with their overall quality of life, 8 (17%) reported no change, and 5 (11%) were worse 2 yr after urethroplasty. Overall, 40 men (87%) remained “satisfied” or “very satisfied” with the outcome of their operation. Health status visual analogue scale scores (100 = best imaginable health, 0 = worst) 2 yr after urethroplasty improved from a mean of 69 at baseline to 79 (mean [95% CI] of differences 10 [2–18], p = 0.018). Health state index scores (1 = full health, 0 = dead) improved from 0.79 at baseline to 0.89 at 2 yr (mean [95% CI] of differences 0.10 [0.02–0.18), p = 0.012]). Conclusions This is the first study to prospectively evaluate urethral reconstruction using a validated PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.