Patient-Reported Outcome Measures in Urethral Reconstruction
- 87 Downloads
Purpose of Review
Treatment of anterior urethral stricture disease (USD) has shifted from endoscopic approaches to urethroplasty with significantly higher success rates among reconstructive urologists. This academic stance has led to a critical evaluation of “success” and developing disease-specific instruments to assess surgical outcomes focusing on patients’ satisfaction rather than the historical goal of avoiding secondary procedures.
Many disease non-specific and/or non-validated patient-reported outcome measures (PROMs) have been utilized to evaluate the voiding symptoms and sexual of function of patients after urethroplasty in the literature. Urethral Stricture Surgery PROM (USS PROM) is the first validated, disease-specific PROM for anterior USD which has been designed in 2001. Urethral Stricture Symptoms and Impact Measure (USSIM) is a comprehensive PROM and is currently being validated at multiple institutions.
This article reviews the tools used to assess success after urethroplasty and elaborates the need to develop a comprehensive USD-specific PROM.
KeywordsUrethral stricture Patient-reported outcome measures Treatment outcome Sexual dysfunction Urination disorders
Compliance with Ethical Standards
Conflict of Interest
Nima Baradaran, Lindsay A. Hampson, Todd C. Edwards, Bryan B. Voelzke, and Benjamin N. Breyer each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3(2):209–13. https://doi.org/10.3978/j.issn.2223-4683.2014.04.07. PubMedPubMedCentralCrossRefGoogle Scholar
- 13.• Erickson BA, Elliott SP, Voelzke BB, Myers JB, Broghammer JA, Smith TG 3rd, et al. Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Urology. 2014;84(1):213–6. https://doi.org/10.1016/j.urology.2014.01.054. Multi-institution report on bulbar urethroplasty with large sample size and close follow-up. CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Bertrand LA, Voelzke BB, Elliott SP, Myers JB, Breyer BN, Vanni AJ, et al. Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol. 2016;196(2):453–61. https://doi.org/10.1016/j.juro.2016.01.117.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Devlin NJ, Appleby J. Getting the most out of PROMs: putting health outcomes at the heart of NHS decision-making. Health Econ 2010:1–92. kingsfund.org.uk/publications%5Cn.http://www.kingsfund.org.uk/publications/proms.html
- 17.•• Jackson MJ, Sciberras J, Mangera A, Brett A, Watkin N, N'Dow JMO, et al. Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol. 2011;60(1):60–8. https://doi.org/10.1016/j.eururo.2011.03.003. First attempt at developing a urethral stricture-specific instrument. This instrument is validated with excellent psychometric values and is widely used by reconstrucive urologists and includes a quality of life component. CrossRefPubMedGoogle Scholar
- 19.•• Breyer BN, Edwards TC, Patrick DL, Voelzke BB. Comprehensive qualitative assessment of urethral stricture disease: toward the development of a patient centered outcome measure. J Urol. 2017;198(5):1113–8. https://doi.org/10.1016/j.juro.2017.05.077. This is the preliminary publication of the process to develop the most comprehensive urethral stricture-specific PROM to date. The instrument is being validated at several centers in the USA. CrossRefPubMedGoogle Scholar
- 20.Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WKCA. The American Urological Association symptom index for benign prostatic hyperplasia. Measure Commit Am Urol Assoc J Urol. 1992;148(5):1549–57.Google Scholar
- 22.Wei JT, Dunn RL, Hoag L, Faerber G, Dorr R, McGuire EJ. The incontinence symptom index (ISI): a novel and practical symptom score for the evaluation of urinary incontinence severity. J Urol. 2003;169(4):S33 abstract 128.Google Scholar
- 27.Nunnally J, Bernstein I. Psychometric theory. 3rd ed. New York: McGraw Hill; 1994.Google Scholar
- 28.Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, et al. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol. 2013;64(5):777–82. https://doi.org/10.1016/j.eururo.2013.04.037.CrossRefPubMedGoogle Scholar
- 36.Mundy AR. Results and complications of urethroplasty and its future. Br J Urol. 1993;71(3):322–5. https://doi.org/10.1111/j.1464-410X.1993.tb15951.x.CrossRefPubMedGoogle Scholar
- 39.• Erickson BA, Granieri MA, Meeks JJ, Mcvary KT, Gonzalez CM. Prospective analysis of ejaculatory function after anterior urethral reconstruction. J Urol. 2010;184(1):238–42. https://doi.org/10.1016/j.juro.2010.03.038. Comprehensive and prospective evaluation of sexual dysfunction after anterior urethroplasty using validated instruments.