title: A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure.
abstract: BACKGROUND
  Studies of interventions for urethral stricture have inferred patient benefit from clinician-driven outcomes or questionnaires lacking scientifically robust evidence of their measurement properties for men with this disease.
  
  
  OBJECTIVE
  To evaluate urethral reconstruction from the patients' perspective using a validated patient-reported outcome measure (PROM).
  
  
  METHODS
  Forty-six men with anterior urethral stricture at four UK urology centres completed the PROM before (baseline) and 2 yr after urethroplasty.
  
  
  METHODS
  A psychometrically robust PROM for men with urethral stricture disease.
  
  
  METHODS
  Lower urinary tract symptoms (LUTS), health status, and treatment satisfaction were measured, and paired t and Wilcoxon matched-pairs tests were used for comparative analysis.
  
  
  CONCLUSIONS
  Thirty-eight men underwent urethroplasty for bulbar stricture and eight for penile stricture. The median (range) follow-up was 25 (20-30) mo. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) improved from a median of 12 at baseline to 4 at 2 yr (mean [95% confidence interval (CI)] of differences 6.6 [4.2-9.1], p < 0.0001). A total of 33 men (72%) felt their urinary symptoms interfered less with their overall quality of life, 8 (17%) reported no change, and 5 (11%) were worse 2 yr after urethroplasty. Overall, 40 men (87%) remained "satisfied" or "very satisfied" with the outcome of their operation. Health status visual analogue scale scores (100 = best imaginable health, 0 = worst) 2 yr after urethroplasty improved from a mean of 69 at baseline to 79 (mean [95% CI] of differences 10 [2-18], p = 0.018). Health state index scores (1 = full health, 0 = dead) improved from 0.79 at baseline to 0.89 at 2 yr (mean [95% CI] of differences 0.10 [0.02-0.18), p = 0.012]).
  
  
  CONCLUSIONS
  This is the first study to prospectively evaluate urethral reconstruction using a validated PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.
authors.affiliation: Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: matthewjackson@me.com.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Jackson
authors.forename: Ishaan
authors.initials: I
authors.lastname: Chaudhury
authors.forename: Altaf
authors.initials: A
authors.lastname: Mangera
authors.forename: Andrew
authors.initials: A
authors.lastname: Brett
authors.forename: Nick
authors.initials: N
authors.lastname: Watkin
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
authors.forename: Daniela E
authors.initials: DE
authors.lastname: Andrich
authors.forename: Robert S
authors.initials: RS
authors.lastname: Pickard
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mundy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking; D006304:Health Status; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011594:Psychometrics; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014525:Urethral Stricture / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000009:adverse effects; D055815:Young Adult
keywords: Outcome assessment (health care); Patient-reported outcome measure; Quality of life; Urethral stricture; Urethral surgery; Urethroplasty