Quality of life as an effectiveness criterion of surgical treatment for anterior urethral strictures
Conclusions: Recent trends in the contemporary medicine have shown a growing request for the personalized choice of treatment and evaluation of its results. PROM-USS questionnaire has been designed for patients undergoing surgical correction of anterior urethral strictures to measure the treatment success using patient reported outcomes in numerical terms.
Objective: To test the effectiveness of different surgical modalities for anterior urethral strictures using patient reported outcomes.
Methods: Ninety men self-completed the PROM-USS questionnaire after surgical treatment of anterior urethral strictures. Mean and median follow-up was 6-132 months and 72 months, respectively. Measures included lower urinary tract symptom score, overall quality of life (QOL) and overall health, and patient satisfaction with treatment.
Results: At the median follow-up of 72 months after surgery for anterior urethral stricture, the survey findings showed LUTS total score 7.4+/-1.2 and urination score on VAS scale 2.3+/-1.1. Sixty-five (72%) of the men believed that residual LUTS did not significantly affect their quality of life. Fifteen (17%) and 10 (11%) patients reported a slight and moderate/strong negative impact of urinary symptoms on their quality of life, respectively. The EQ-5D score of overall health state on VAS was 73+/-4.2 out of 100, the EQ-5D score of the overall quality of life was 0.79+/-0.2. Seventy-eight (86.7%) of 90 men were satisfied (32.2% very satisfied and 54.5% satisfied) with the surgery results, and 12 (13.3%) were dissatisfied. Reasons for dissatisfaction were the emergence of new problems (post-micturition dribbling) with an overall improvement of urinary symptoms (5) and the lack of improvement in urinary symptoms (7). Among patients treated with OIU, 79% were satisfied, which was significantly less than in groups of men who underwent anastomotic urethroplasty - 89% (p<0.05) and substitution urethroplasty using a buccal mucosal grafting - 95% (p<0.05).
Conclusions: The patient-reported outcomes showed that surgery for anterior urethral stricture is highly effective and characterized by a long term patient satisfaction and quality of life.