|
NEUROUROLOGY
& FEMALE UROLOGY
The
expectations of patients who undergo surgery for stress incontinence
Mallett VT, Brubaker L, Stoddard AM, Borello-France D, Tennstedt S, Hall
L, Hammontree L; Urinary Incontinence Treatment Network
Department of Obstetrics and Gynecology, University of Tennessee Health
Science Center, Memphis, TN 38138, USA
Am J Obstet Gynecol. 2008; 198: 308.e1-6
- Objective:
The purpose of this study was to assess patient expectations of surgical
outcome after preoperative counseling of surgical procedures in a randomized
trial of 655 women in a comparison of the rectus fascial sling and Burch
colposuspension.
-
Study Design:
Women who selected surgery for treating stress incontinence and who
consented to this randomized, surgical trial completed a preoperative
questionnaire to assess expectations for the postsurgical effects of
surgery on urinary incontinence-related symptoms, limitations, and emotions.
Associations of expectations with a range of preoperative urinary incontinence
measures were explored.
-
Results: The
most frequent preoperative symptoms were urine leakage (98%), embarrassment
(88%), frequency (74%), physical activity (72%), and urgency (70%).
Sexual and social limitations were less frequent (< or = 44%). Treatment
expectations were higher for women who reported more symptom bother.
As expected, most women (98%) had an expectation that urine leakage
would be completely or almost completely eliminated. However, most women
(92%) who reported urgency or frequency (83%) expected significant improvement
of these symptoms after surgery.
-
Conclusion:
Patients who undergo stress incontinence surgery have high expectations
regarding the outcome of incontinence surgery, which include the resolution
of urgency and frequency.
- Editorial
Comment
The authors reviewed the expectations of patients with regards to the
anticipated results of their upcoming anti-incontinence operation (be
it a Burch urethropexy or a autologous fascial suburethral sling). The
patients had a consultation with their surgeon as well as viewing a
standardized video presentation on the future surgery. The discussion
of expectations and explanation of risks and benefits of surgery was
standardized among the 22 surgeons at all the participating study sites.
Even after both a video presentation and verbal discussion, 92% of the
patients still expected that their urgency symptoms would resolve and
74% that their urinary frequency would improve with an anti-incontinence
operation. Expectations were not related to preoperative health, age,
physical examination or history of previous surgery.
An interesting article that formalizes the anecdotal experience of urologic
surgeons: no matter how intensive the preoperative counseling and explanation
of risks and benefits, patients expect an anti-incontinence operation
will address all aspects of their voiding dysfunction. It has been noted
in the past that a certain percent of patients will have their urgency
addressed with an anti-stress incontinence operation (1). The segment
in whom the urgency persists will definitely report a lower satisfaction
with their surgery even with a technically perfect procedure (2).
References
1. McGuire EJ, Savastano JA: Stress incontinence and detrusor instability/urge
incontinence. Neurourol Urodyn 1985; 4: 313-6.
2. Haab F, Trockman BA, Zimmern PE, Leach GE: Results of pubovaginal sling
for the treatment of intrinsic sphincteric deficiency determined by questionnaire
analysis. J Urol. 1997; 158: 1738-41.
Steven
P. Petrou, M.D
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu |