Patient-reported outcomes combined with objective data to evaluate outcomes after urethral reconstruction

Jessica DeLong, Jill Buckley
Urology 2013, 81 (2): 432-6

OBJECTIVE: To report patients' perceptions of urethral reconstruction outcomes by comparing the results from preoperative and postoperative symptom questionnaires and to propose a standardized method of follow-up that includes patient satisfaction questionnaires and objective cystoscopic evaluation to facilitate comparison of different urethral reconstructive techniques and outcomes among surgeons and institutions.

MATERIALS AND METHODS: Data were prospectively collected for 110 consecutive patients undergoing urethral reconstruction. Patient demographics, American Urological Association Symptom Score, quality of life score, International Index of Erectile Function score, flow rate, and postvoid residual urine volume were collected pre- and postoperatively. The patients were evaluated at 3 and 6 months postoperatively and then yearly. Flexible cystoscopy (17F) was performed at 6 months postoperatively. The Wilcoxon signed rank test and Mann-Whitney U test were used to compare the pre- and post-test distributions. One-way analysis of variance was used to compare the mean values among groups.

RESULTS: The mean patient age was 47 years, and the mean stricture length was 4.9 cm. Of the 110 patients, 32 received anastomotic (29%), 60 onlay (55%), 7 staged (6%), and 11 fasciocutaneous flap (10%) urethroplasty. The median individual change comparing the pre- and postoperative data was an improvement of 11 for the American Urological Association Symptom Score (P <.0001), 4 for the quality of life score (P <.0001), and 0 for International Index of Erectile Function (P = .05). No unifying individual follow-up questionnaire or flow rate correlated with recurrence.

CONCLUSION: Patients undergoing urethral reconstruction reported significant improvement in urinary bother and quality of life scores while maintaining or improving their erectile function. Cystoscopic evaluation can be a valuable component of the postoperative follow-up algorithm, providing a consistent data point for comparison and confirming the patency of repair. Standardization of the measured outcomes is critical to validate the reported urethral reconstructive outcomes.

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