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MP3-11 DETERMINANTS OF PATIENT SATISFACTION AFTER ANTERIOR URETHROPLASTY
THE JOURNAL OF UROLOGYâ
e38
Vol. 191, No. 4S, Supplement, Friday, May 16, 2014
RESULTS: Twenty-six patients met study criteria. The patient demographics, median operative time, estimated blood loss and estimated stricture length are reported in Table 1. The stricture involved the posterior urethra in 22/26 cases. By our strict definition, 73% of patients achieved success. The median time to failure was 2.4 mo range (range 1.4 e 24.1). Of the six failures one has undergone repeat anastomotic urethroplasty and two have undergone bladder neck incision with a median successful cystoscopic follow up of 20 mo (range 5 e 29). Two require continued suprapubic drainage and the one underwent an ileal conduit. The final patient has an asymptomatic recurrence of <17 Fr. Of the 22 subjects with cystoscopic success (19 initial successes and 3 successes after subsequent procedure), 15/22 had postoperative incontinence. Artificial urinary sphincters have been placed in 9/15 at a median time of 7 months (range 6 e 24) from initial repair. A transcorporal approach was utilized in 4/9 patients. There have been two erosions, one transcorporal and one non-transcorporal, 7.2 and 3.6 months after placement. Clavian classification I or II complications occurred 7/26 patients and were predominantly transient perineal or scrotal pain. All Clavian classification III complications were the result of urethroplasty failure and are discussed above. CONCLUSIONS: Anastomotic urethroplasty after radiation therapy is a feasible technique to restore patency of the urethra. Patients should be counseled that adjuvant surgery to treat stress incontinence might be necessary. Success
Success
Failure
Failure
Number
%
Number
%
DeMOGRAPHICS n
19
7
Median Age (yrs)
66
77
BMI > 30
4
21.1
1
14.3
Diabetes
5
26.3
2
28.6
Prostate Cancer Therapy Prostatectomy
3
15.8
1
14.3
EBRT
14
73.7
4
57.1
Brachytherapy
6
31.6
2
28.6
> one type of XRT
2
10.5
3
42.9
Operative time (min)
233
278
Estimated blood loss (cc)
317
220
Estimated stricture
2.2
3.1
Intraoperative
important to surgeons with our changing healthcare system. The purpose of this study was to analyze what factors, besides traditional surgical success, are predictors of patient satisfaction after anterior urethroplasty. METHODS: Between June 2010 and July 2013, men with anterior urethral stricture disease were enrolled in a prospective, multiinstitutional, urethroplasty outcomes study. Postoperative satisfaction was assessed by asking men on a five-point likert scale, “Were you satisfied with your surgical procedure?”. Potential predictor variables analyzed using uni- and multivariate techniques included standard patient and stricture characteristics, questionnaire data (International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire Ejaculation (MSHQ - Ej), Sexual Health Inventory for Men (SHIM), and other sexual function questions), uroflowmetry, and stricture recurrence (determined by cystoscopy). Postoperative testing occurred at 3 and 12 months. RESULTS: There were 131 patients that completed pre/post op satisfaction questionnaires, of which 114 (87%) were either very satisfied or satisfied after their surgery and 17 (13%) were neither satisfied/ unsatisfied or unsatisfied/very unsatisfied at a median follow-up time of 10 months. Univariate predictors for patient satisfaction included: prior urethroplasty (No (93%) vs. Yes (69%); p ¼ 0.0008), stricture location (bulbar (92%) vs. penile (72%); p ¼ 0.024), altered intercourse frequency (versus pre-op) (No (94%) vs. Yes (69%); p ¼ 0.0004) and new onset penile curvature (No (90%) vs. Yes (71%); p ¼ 0.02). Recurrence was noted in 11 (8%) men but was not predictive of satisfaction (p¼0.13). Changes in postoperative voiding symptoms, quality of life (QOL) and uroflowmetry were also associated with postoperative satisfaction (Table). On multivariable analysis, initial urethroplasty (versus repeat; OR 20.8), stable intercourse frequency (versus decreased; OR 8.9), and improved post-op urinary QOL (OR 2.3) were independent satisfaction predictors. CONCLUSIONS: Patient satisfaction was high after urethral reconstruction. Dissatisfaction was associated with lower improvements on voiding questionnaires, lower patient reported QOL improvements, lower post-op urinary flow rates, negative sexual side-effects, and in patients undergoing repeat urethroplasty. Table: Patient Reported Outcomes After Urethral Reconstruction By Postoperative Satisfaction.
Considerations
length (cm) Adjuvant Surgical Maneurvers Transperineal approach
18
94.7
5
71.4
Abdominal & perineal
1
5.3
2
28.6
approach
Unsatisfied Mean (SD)
Satisfied Mean (SD)
p-value
Post-op IPSS Total
9.44 (8.51)
1.13 (4.50)
0.0371
D IPSS Total
7.06 (11.16)
12.12 (10.73)
0.084
D MSHQ (Ej) Total
-0.75 (6.70)
-2.56 (4.57)
0.3127
D SHIM
0.82 (7.67)
0.30 (5.11)
0.7199
D CLSS Total
4.94 (6.31)
8.89 (6.48)
0.0266 0.0002
Gracilis muscle flap
6
31.6
2
28.6
D CLSS QOL
1.13 (1.36)
3.27 (2.10)
Corporal Spllitting
9
47.4
2
28.6
Post-op Max Flow Rate (mL/sec)
17.4 (6.05)
22.94 (12.46)
0.0081
Partial pubectomy
1
5.3
1
14.3
D Max Flow Rate
8.51 (6.36)
14.32 (13.85)
0.0647
Partial/salvage
5
26.3
0
0.0
Clavian I or II
6
31.6
1
14.3
Clavian III
0
0.0
6
85.7
prostatectomy Complications
Source of Funding: Unrestricted grant provided by the Joe W. & Dorothy Dorsett Brown Foundation
Source of Funding: None
MP3-12 MP3-11 DETERMINANTS OF PATIENT SATISFACTION AFTER ANTERIOR URETHROPLASTY Gareth Warren*, Bradley Erickson, Iowa City, IA; Laura Bertrand, Iowa City, IA; Sean Elliott, Minneapolis, MN; Jeremy Myers, Salt Lake City, UT; Christopher McClung, Columbus, OH; Bryan Voelzke, Seattle, WA; for the Trauma and Urologic Reconstruction Network of SurgeonsIowa City, IA INTRODUCTION AND OBJECTIVES: Patient reported surgical outcomes, including overall satisfaction, will become increasingly
PATIENT REPORTED QUALITY OF LIFE IN MEN WITH COMPLICATIONS RELATED TO PEDIATRIC HYPOSPADIAS REPAIR Daniel Stein*, Bayard Carlson, D. Joseph Thum, Jessica Casey, Chris Gonzalez, Chicago, IL INTRODUCTION AND OBJECTIVES: Assessment of health related quality of life (HRQL) in adult patients with prior failed hypospadias remains important for clinical decision making and assessment of patient outcomes. Currently, no standardized outcome measure exists for this cohort and established tools are largely based on
e38
Vol. 191, No. 4S, Supplement, Friday, May 16, 2014
RESULTS: Twenty-six patients met study criteria. The patient demographics, median operative time, estimated blood loss and estimated stricture length are reported in Table 1. The stricture involved the posterior urethra in 22/26 cases. By our strict definition, 73% of patients achieved success. The median time to failure was 2.4 mo range (range 1.4 e 24.1). Of the six failures one has undergone repeat anastomotic urethroplasty and two have undergone bladder neck incision with a median successful cystoscopic follow up of 20 mo (range 5 e 29). Two require continued suprapubic drainage and the one underwent an ileal conduit. The final patient has an asymptomatic recurrence of <17 Fr. Of the 22 subjects with cystoscopic success (19 initial successes and 3 successes after subsequent procedure), 15/22 had postoperative incontinence. Artificial urinary sphincters have been placed in 9/15 at a median time of 7 months (range 6 e 24) from initial repair. A transcorporal approach was utilized in 4/9 patients. There have been two erosions, one transcorporal and one non-transcorporal, 7.2 and 3.6 months after placement. Clavian classification I or II complications occurred 7/26 patients and were predominantly transient perineal or scrotal pain. All Clavian classification III complications were the result of urethroplasty failure and are discussed above. CONCLUSIONS: Anastomotic urethroplasty after radiation therapy is a feasible technique to restore patency of the urethra. Patients should be counseled that adjuvant surgery to treat stress incontinence might be necessary. Success
Success
Failure
Failure
Number
%
Number
%
DeMOGRAPHICS n
19
7
Median Age (yrs)
66
77
BMI > 30
4
21.1
1
14.3
Diabetes
5
26.3
2
28.6
Prostate Cancer Therapy Prostatectomy
3
15.8
1
14.3
EBRT
14
73.7
4
57.1
Brachytherapy
6
31.6
2
28.6
> one type of XRT
2
10.5
3
42.9
Operative time (min)
233
278
Estimated blood loss (cc)
317
220
Estimated stricture
2.2
3.1
Intraoperative
important to surgeons with our changing healthcare system. The purpose of this study was to analyze what factors, besides traditional surgical success, are predictors of patient satisfaction after anterior urethroplasty. METHODS: Between June 2010 and July 2013, men with anterior urethral stricture disease were enrolled in a prospective, multiinstitutional, urethroplasty outcomes study. Postoperative satisfaction was assessed by asking men on a five-point likert scale, “Were you satisfied with your surgical procedure?”. Potential predictor variables analyzed using uni- and multivariate techniques included standard patient and stricture characteristics, questionnaire data (International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire Ejaculation (MSHQ - Ej), Sexual Health Inventory for Men (SHIM), and other sexual function questions), uroflowmetry, and stricture recurrence (determined by cystoscopy). Postoperative testing occurred at 3 and 12 months. RESULTS: There were 131 patients that completed pre/post op satisfaction questionnaires, of which 114 (87%) were either very satisfied or satisfied after their surgery and 17 (13%) were neither satisfied/ unsatisfied or unsatisfied/very unsatisfied at a median follow-up time of 10 months. Univariate predictors for patient satisfaction included: prior urethroplasty (No (93%) vs. Yes (69%); p ¼ 0.0008), stricture location (bulbar (92%) vs. penile (72%); p ¼ 0.024), altered intercourse frequency (versus pre-op) (No (94%) vs. Yes (69%); p ¼ 0.0004) and new onset penile curvature (No (90%) vs. Yes (71%); p ¼ 0.02). Recurrence was noted in 11 (8%) men but was not predictive of satisfaction (p¼0.13). Changes in postoperative voiding symptoms, quality of life (QOL) and uroflowmetry were also associated with postoperative satisfaction (Table). On multivariable analysis, initial urethroplasty (versus repeat; OR 20.8), stable intercourse frequency (versus decreased; OR 8.9), and improved post-op urinary QOL (OR 2.3) were independent satisfaction predictors. CONCLUSIONS: Patient satisfaction was high after urethral reconstruction. Dissatisfaction was associated with lower improvements on voiding questionnaires, lower patient reported QOL improvements, lower post-op urinary flow rates, negative sexual side-effects, and in patients undergoing repeat urethroplasty. Table: Patient Reported Outcomes After Urethral Reconstruction By Postoperative Satisfaction.
Considerations
length (cm) Adjuvant Surgical Maneurvers Transperineal approach
18
94.7
5
71.4
Abdominal & perineal
1
5.3
2
28.6
approach
Unsatisfied Mean (SD)
Satisfied Mean (SD)
p-value
Post-op IPSS Total
9.44 (8.51)
1.13 (4.50)
0.0371
D IPSS Total
7.06 (11.16)
12.12 (10.73)
0.084
D MSHQ (Ej) Total
-0.75 (6.70)
-2.56 (4.57)
0.3127
D SHIM
0.82 (7.67)
0.30 (5.11)
0.7199
D CLSS Total
4.94 (6.31)
8.89 (6.48)
0.0266 0.0002
Gracilis muscle flap
6
31.6
2
28.6
D CLSS QOL
1.13 (1.36)
3.27 (2.10)
Corporal Spllitting
9
47.4
2
28.6
Post-op Max Flow Rate (mL/sec)
17.4 (6.05)
22.94 (12.46)
0.0081
Partial pubectomy
1
5.3
1
14.3
D Max Flow Rate
8.51 (6.36)
14.32 (13.85)
0.0647
Partial/salvage
5
26.3
0
0.0
Clavian I or II
6
31.6
1
14.3
Clavian III
0
0.0
6
85.7
prostatectomy Complications
Source of Funding: Unrestricted grant provided by the Joe W. & Dorothy Dorsett Brown Foundation
Source of Funding: None
MP3-12 MP3-11 DETERMINANTS OF PATIENT SATISFACTION AFTER ANTERIOR URETHROPLASTY Gareth Warren*, Bradley Erickson, Iowa City, IA; Laura Bertrand, Iowa City, IA; Sean Elliott, Minneapolis, MN; Jeremy Myers, Salt Lake City, UT; Christopher McClung, Columbus, OH; Bryan Voelzke, Seattle, WA; for the Trauma and Urologic Reconstruction Network of SurgeonsIowa City, IA INTRODUCTION AND OBJECTIVES: Patient reported surgical outcomes, including overall satisfaction, will become increasingly
PATIENT REPORTED QUALITY OF LIFE IN MEN WITH COMPLICATIONS RELATED TO PEDIATRIC HYPOSPADIAS REPAIR Daniel Stein*, Bayard Carlson, D. Joseph Thum, Jessica Casey, Chris Gonzalez, Chicago, IL INTRODUCTION AND OBJECTIVES: Assessment of health related quality of life (HRQL) in adult patients with prior failed hypospadias remains important for clinical decision making and assessment of patient outcomes. Currently, no standardized outcome measure exists for this cohort and established tools are largely based on