Patient reported objective and experience measures to assess satisfaction, service evaluation and outcomes following post prostatectomy stress urinary incontinence surgery

Chedid Y1, Sheimar K1, Solomon E1, Taylor C1, Malde S1, Sahai A1

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Abstract 563
E-Poster 3
Scientific Open Discussion ePoster Session 31
Friday 6th September 2019
13:05 - 13:10 (ePoster Station 2)
Exhibition Hall
Incontinence Stress Urinary Incontinence Surgery
1.Guy's and St Thomas' NHS Foundation Trust
Presenter
K

Kieran Sheimar

Links

Abstract

Hypothesis / aims of study
Very few studies report on patient experience through their pathway following incontinence surgery. The aim of this study was to investigate the outcomes of the male sling (MS; AdVance XP™) and the Artificial Urinary Sphincter (AUS; AMS 800™) in the treatment of bothersome post-prostatectomy stress urinary incontinence (PPSUI). In addition, patient experience and satisfaction following surgery was evaluated using a validated patient reported experience measure (PREM) and patient reported outcome measures (PROMs).
Study design, materials and methods
In this single centre prospective study, we assessed outcomes in 91 males who had received treatment with a MS or AUS between 2013 and 2017. Patients were asked to complete the ICIQ:UI-SF, MLUTS, and LUTSQoL pre-operatively, and then at each follow-up visit. Patients with a minimum follow up of 1 year were also contacted and completed 2 questionnaires; the client satisfaction questionnaire (CSQ-8), and treatment benefit scale (TBS). In general patients with mild incontinence (24 hour pad weight < 100g) were treated with a MS and those with severe incontinence (24 hour pad weight > 500g) or whom had a history of radiotherapy were treated with an AUS. Those with moderate incontinence without radiotherapy (24 hour pad weight 100-500g) were offered a choice of either MS or AUS.
Results
PPSUI was as a result of radical prostatectomy in 94% of cases. 38 patients received a MS, whilst 48 received an AUS. Five patients (5.3%) were excluded due to incomplete questionnaires. The mean follow-up was 32 months (range 12 to 60). In the MS group, daily pad use fell from 2.84 to 0.52 at 1-year (p < 0.001). ICIQ-UI SF scores improved from 16.47 to 5.14 (P < 0.001), ICIQ-MLUTS from 19.23 to 12.33 and ICIQ-LUTSQoL from 45.00 to 30.47 at 1-year follow up. In the AUS group, there were significant reductions in the number of pads used per day from an average of 4.00 pre-operatively to 0.52 at 1-year. (p < 0.000). ICIQ-UI SF scores fell from 18.35 to 5.62, ICIQ-MLUTS scores fell from 27.58 to 12.63 and ICIQ-LUTSQoL scores from 54.50 to 26.00. Seventy-five patients had at least one year follow up. The mean CSQ-8 score was 29.8 (S.D. 3.60) out of 32. The mean TBS score was 1.54 (S.D. 0.84) out of 4. 65 patients (85.5%) gave a score of at least 1 or 2 showing that the treatment improved or greatly improved their condition. High CSQ-8 and low TBS scores showed a statistically significant correlation of -0.823 (P=0.01). Complication rates were higher in the AUS group 24.1% vs 15.4%. AUS revision or removal surgery rate over the study period duration was 10%. In the MS group 11% have undergone or are planned AUS surgery.
Interpretation of results
Our study suggests this protocolised approach to PPSUI is effective. ICIQ scores decrease which suggest an improvement in incontinence, symptoms and quality of life. High CSQ-8 scores indicate excellent satisfaction with the service. Low TBS scores indicate a high level of patient satisfaction with treatment and this appears to be correlated to those who report receiving a good service. Complications are in keeping with the published literature.
Concluding message
Our data demonstrates that the AUS and MS are safe and efficacious treatment options in males with post-prostatectomy urinary incontinence utilising a protocolled approach. A reduction in validated objective and subjective outcomes were observed in the vast majority of patients post-operatively. Mean CSQ-8 scores were high, along with individual domains indicating a very high satisfaction with the service provided. TBS scores were low indicating high patient satisfaction with treatment. PREMs and PROMs should be more widely utilized to fully capture the patient experience and to fully evaluate the efficacy of such procedures in future studies.
Disclosures
Funding none Clinical Trial No Subjects Human Ethics not Req'd service evaluation audit; local R&D approval 7923 Helsinki Yes Informed Consent Yes