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Re: Lessons from a Patient Experience Survey in a Randomized Surgical Trial of Treatment of Stress Urinary Incontinence in Women
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SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
depression association could not be assessed. Conclusions: Nocturia is associated with decreased QOL and with an increased prevalence of depressive symptoms in both men and women. Editorial Comment: Having to get up 2 or more times a night to void seems to be the threshold value in this article, although in examining the data there is a pretty marked difference between 3 times and 2 times. It will be very interesting to see whether a reverse parallel variation exists if safe and effective treatment for nocturia over a long duration or permanently becomes a standard and frequently used part of our therapeutic armamentarium. In other words, in these individuals, does just decreasing the nocturia result in a lowering of these associations and the other comorbidities for which nocturia is cited as a contributing factor? Alan J. Wein, M.D., Ph.D. (hon.)
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: Lessons from a Patient Experience Survey in a Randomized Surgical Trial of Treatment of Stress Urinary Incontinence in Women P. E. Zimmern, K. J. Dandreo, L. Sirls, A. Howell, L. Hall, J. Gruss, K. Jesse, T. Dickinson and C. Prather UT Southwestern Medical Center, Dallas, Texas Int Urogynecol J 2011; 22: 1273–1278.
Introduction and Hypothesis: To understand the patient burden of study procedures/measures at completion of a randomized controlled trial (RCT) requiring extensive testing and follow-up visits. Methods: A survey sent after completing the 2-year visit of an RCT comparing Burch colposuspension and fascial retropubic sling to treat stress urinary incontinence assessed degree of bother for seven study procedures, eight study-related factors, and possible motivations to participate in the study. Results: A total of 450 study participants (88%) returned the survey. Urodynamic testing was the most bothersome procedure, followed by 24-h pad test and Q-tip test. Self-administered questionnaires were the least bothersome. Main reasons to participate in the study were to help others, obtain better knowledge about the condition, and be guided by a committed team of investigators/study coordinators. Conclusions: At the end of a large multicenter RCT, we learned from a confidential patient survey that the most burdensome activities involved invasive procedures, frequent visits, and multiple forms to fill out. Editorial Comment: As urologists, we routinely order and perform urodynamic testing for our patients and generally consider it a relatively noninvasive, low risk test. This study indicates that urodynamic testing might not be as easy on our patients as we thought. Acknowledging that this report is from a randomized clinical trial (which may influence its generalizability), the findings indicate that 30% of patients undergoing urodynamics found it a moderate or major bother and half noted that it was the most bothersome study procedure they underwent. Next time you order urodynamics for your patient, consider whether the information you will obtain is worth the bother you will cause your patient. David F. Penson, M.D., M.P.H.
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
depression association could not be assessed. Conclusions: Nocturia is associated with decreased QOL and with an increased prevalence of depressive symptoms in both men and women. Editorial Comment: Having to get up 2 or more times a night to void seems to be the threshold value in this article, although in examining the data there is a pretty marked difference between 3 times and 2 times. It will be very interesting to see whether a reverse parallel variation exists if safe and effective treatment for nocturia over a long duration or permanently becomes a standard and frequently used part of our therapeutic armamentarium. In other words, in these individuals, does just decreasing the nocturia result in a lowering of these associations and the other comorbidities for which nocturia is cited as a contributing factor? Alan J. Wein, M.D., Ph.D. (hon.)
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: Lessons from a Patient Experience Survey in a Randomized Surgical Trial of Treatment of Stress Urinary Incontinence in Women P. E. Zimmern, K. J. Dandreo, L. Sirls, A. Howell, L. Hall, J. Gruss, K. Jesse, T. Dickinson and C. Prather UT Southwestern Medical Center, Dallas, Texas Int Urogynecol J 2011; 22: 1273–1278.
Introduction and Hypothesis: To understand the patient burden of study procedures/measures at completion of a randomized controlled trial (RCT) requiring extensive testing and follow-up visits. Methods: A survey sent after completing the 2-year visit of an RCT comparing Burch colposuspension and fascial retropubic sling to treat stress urinary incontinence assessed degree of bother for seven study procedures, eight study-related factors, and possible motivations to participate in the study. Results: A total of 450 study participants (88%) returned the survey. Urodynamic testing was the most bothersome procedure, followed by 24-h pad test and Q-tip test. Self-administered questionnaires were the least bothersome. Main reasons to participate in the study were to help others, obtain better knowledge about the condition, and be guided by a committed team of investigators/study coordinators. Conclusions: At the end of a large multicenter RCT, we learned from a confidential patient survey that the most burdensome activities involved invasive procedures, frequent visits, and multiple forms to fill out. Editorial Comment: As urologists, we routinely order and perform urodynamic testing for our patients and generally consider it a relatively noninvasive, low risk test. This study indicates that urodynamic testing might not be as easy on our patients as we thought. Acknowledging that this report is from a randomized clinical trial (which may influence its generalizability), the findings indicate that 30% of patients undergoing urodynamics found it a moderate or major bother and half noted that it was the most bothersome study procedure they underwent. Next time you order urodynamics for your patient, consider whether the information you will obtain is worth the bother you will cause your patient. David F. Penson, M.D., M.P.H.