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

Lookup NU author(s): Dr Matthew Jackson, Rob Pickard

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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. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Publication metadata

Author(s): Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, Andrich DE, Pickard RS, Mundy AR

Publication type: Article

Publication status: Published

Journal: European Urology

Year: 2013

Volume: 64

Issue: 5

Pages: 777-782

Print publication date: 01/11/2013

Online publication date: 01/05/2013

Acceptance date: 19/04/2013

ISSN (print): 0302-2838

ISSN (electronic): 1873-7560

Publisher: Elsevier BV

URL: http://dx.doi.org/10.1016/j.eururo.2013.04.037

DOI: 10.1016/j.eururo.2013.04.037

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