How cure rates drive patients' preference for urethral bulking agent or mid-urethral sling surgery as therapy for stress urinary incontinence
| Autor: | Rosa A. Enklaar, Jan-Paul W. R. Roovers, Ikram El Bouyahyaoui, Fenne M. Casteleijn, Stephen Jeffery, Sandra E. Zwolsman |
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| Přispěvatelé: | Graduate School, Obstetrics and Gynaecology, ARD - Amsterdam Reproduction and Development, APH - Methodology, APH - Personalized Medicine, APH - Digital Health, APH - Aging & Later Life |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Sling (implant) Time Factors Urology Sedation Urinary Incontinence Stress 030232 urology & nephrology Patient characteristics Urinary incontinence Mid-Urethral Sling 03 medical and health sciences 0302 clinical medicine Urethra Interquartile range medicine Humans Pain Management Aged Suburethral Slings 030219 obstetrics & reproductive medicine business.industry Spinal anesthesia Patient Preference Middle Aged Patient preference Surgery Treatment Outcome Urologic Surgical Procedures Female Neurology (clinical) medicine.symptom business |
| Zdroj: | Neurourology and urodynamics, 38(5), 1384-1391. Wiley-Liss Inc. |
| ISSN: | 0733-2467 |
| Popis: | Aims To assess the patients' median-accepted threshold of cure rate for urethral bulking agent (UBA) treatment compared to mid-urethral sling (MUS) surgery for treatment of female stress urinary incontinence (SUI). Secondly, to determine the correlation between treatment trade-off point and patient characteristics. Methods Women older than 18 years, with predominant SUI, seeking treatment, underwent a structured interview. The treatment trade-off point was determined in scenario one: UBA vs transobturator standard MUS surgery (SMUS) performed under general/spinal anesthesia with one-night hospital stay, and scenario 2: UBA compared to single-incision MUS surgery (SIMS) performed under local analgesia (with sedation) in a daycare setting. The treatment trade-off point was assessed by decreasing the cure rate of UBA from 85% to 10% with steps of 2% until the patient's treatment preference switched to SMUS/SIMS. Results One hundred and five patients were interviewed. Mean age was 52 years (SD, ±13.4). The median trade-off point for scenarios 1 and 2 was 79% (interquartile range [IQR]: 69, 85) and 85% (IQR: 71, 85), respectively. Patients with longer duration of SUI symptoms were willing to trade more efficacy to prefer UBA treatment. Conclusions Patients with SUI are willing to trade a lower cure rate to prefer UBA over SMUS to avoid hospitalization and general anesthesia. When SIMS is performed in a daycare setting under local analgesia, the majority of patients with SUI are of the opinion that cure rates of UBA should be at least as high as SIMS to be worth considering. The treatment preference is not strongly correlated with the patients' characteristics. |
| Databáze: | OpenAIRE |
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