title: Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures.
abstract: OBJECTIVE
  Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.
  
  
  METHODS
  Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.
  
  
  RESULTS
  At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07-11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05-2.77 and OR 2.74, 95% CI 1.12-6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07-11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction.
  
  
  CONCLUSIONS
  Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bertrand
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Department of Urology, University of Utah, Salt Lake City, Utah.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.affiliation: Department of Urology, Ohio State University, Columbus, Ohio.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: McClung
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Tam
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Warren
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: brad-erickson@uiowa.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003558:Cystoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012008:Recurrence; D012042:Registries; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures; D055815:Young Adult
keywords: erectile dysfunction; lower urinary tract symptoms; pain; patient satisfaction; urethral stricture