title: Are patients willing to trade cure rate against less pain? Patients' preferences for single incision midurethral sling or transobturator standard midurethral sling.
abstract: OBJECTIVE
  To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS).
  
  
  METHODS
  A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS.
  
  
  RESULTS
  To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI.
  
  
  CONCLUSIONS
  Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.
authors: Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands.
authors: René P
authors: RP
authors: Schellart
authors: Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors: Fenne M
authors: FM
authors: Casteleijn
authors: Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors: Marcel G W
authors: MGW
authors: Dijkgraaf
authors: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors: Manuela
authors: M
authors: Tutolo
authors: Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors: Jan-Paul W R
authors: JWR
authors: Roovers
mesh_terms: D005260:Female; D006119:Groin; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000523:psychology; D010146:Pain / Q000209:etiology / Q000601:surgery*; D057240:Patient Preference; D019919:Prosthesis Implantation / Q000523:psychology*; D011788:Quality of Life; D053825:Suburethral Slings / Q000523:psychology; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000523:psychology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000523:psychology
keywords: midurethral sling; preference study; stress urinary incontinence; trade-off experiment