Dataset Information

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions.

ABSTRACT:

Purpose

When seeking treatment for male stress urinary incontinence (mSUI), patients are faced with weighing complex risks and benefits in making treatment decisions within their individual context. We sought to quantify the frequency of decisional regret among this population and to determine factors associated with regret.

Materials and methods

A cohort of 130 males aged ≥65 years seen for initial mSUI consultation at the University of California, San Francisco Medical Center and the San Francisco Veterans Affairs Medical Center between June 2015 and March 2020 was developed. Using retrospective chart review and telephone interviews, we ascertained decisional regret as well as other patient-, disease- and treatment-related characteristics. Decisional regret was analyzed by treatment type and patient-, disease- and treatment-related factors. Multivariable logistic regression models were built to examine the factors most associated with decisional regret.

Results

Among the entire cohort, 22% reported moderate to severe decisional regret. Regret was highest among those electing conservative management, with 34.7% having decisional regret (vs with surgery: 8.3% sling, 8.2% sphincter; p <0.001). In multivariable analysis, depression, lower rating of shared decision making and higher current incontinence scores were significantly associated with decisional regret.

Conclusions

Recognition of depression, improved efforts at shared decision making and more individualized treatment counseling have the potential to improve patient satisfaction with treatment choice. In addition, given high levels of regret among those electing conservative treatment, we may be underutilizing mSUI surgery in this population.

SUBMITTER: Hampson LA

PROVIDER: S-EPMC8966413 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions.

Hampson Lindsay A LA Suskind Anne M AM Breyer Benjamin N BN Cooperberg Matthew R MR Sudore Rebecca L RL Keyhani Salomeh S Allen I Elaine IE Walter Louise C LC

The Journal of urology 20211202 4

<h4>Purpose</h4>When seeking treatment for male stress urinary incontinence (mSUI), patients are faced with weighing complex risks and benefits in making treatment decisions within their individual context. We sought to quantify the frequency of decisional regret among this population and to determine factors associated with regret.<h4>Materials and methods</h4>A cohort of 130 males aged ≥65 years seen for initial mSUI consultation at the University of California, San Francisco Medical Center an ...[more]

PMID: 34854756

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Project description:BackgroundFrailty is common among urology patients in general as well as among men seeking evaluation for stress urinary incontinence (SUI), with 6.1% of men undergoing artificial urinary sphincter placement considered frail. It is unclear if and how patient views on frailty and incontinence severity impact decision-making with regards to SUI treatment.MethodsWe undertook a mixed methods analysis to evaluate the intersection of frailty, incontinence severity, and treatment decision-making is presented. To do so, we utilized a previously published cohort of men undergoing evaluation for SUI at the University of California, San Francisco between 2015 and 2020, selecting those who had evaluation with timed up and go test (TUGT), objective measures of incontinence, and patient-reported outcome measures (PROMs). A subset of these participants had additionally undergone semi-structured interviews, and these interviews were re-examined to thematically code them with a focus on the impact of frailty and incontinence severity on SUI treatment decision-making.ResultsAmong the original cohort of 130 patients, 72 had an objective measure of frailty and were included in our analysis; 18 of these individuals had corresponding qualitative interviews. Common themes identified included (I) impact of incontinence severity on decision-making; (II) the interaction between frailty and incontinence; (III) the impact of comorbidity on treatment decision-making; and (IV) age as a construct of frailty and impact on surgical choice and/or recovery. Direct quotations regarding each theme provides insight into patients' views and drivers of SUI treatment decision-making.ConclusionsThe impact of frailty on treatment decision-making for patients with SUI is complex. This mixed methods study highlights the variety of patient views on frailty with regards to surgical intervention for male SUI. Urologists should make a concerted effort to personalize patient counseling for SUI management and take time to understand each patient's perspective in order to individualize SUI treatment decision-making. More research is needed to help identify factors that influence decision-making for frail male patients with SUI.

Project description:Background Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research. Methods The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI’s Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI’s three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis. Results Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson’s disease (n = 7). Conclusion There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area. Registration A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/]. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-023-04249-7.

Project description:ObjectiveTo identify factors that may predict success and satisfaction in women undergoing nonsurgical therapy for stress urinary incontinence.MethodsBaseline demographic and clinical characteristics of women participating in a multicenter randomized trial of pessary, behavioral, or combined therapy for stress urinary incontinence were evaluated for potential predictors of success and satisfaction. Success and satisfaction outcomes were assessed at 3 months and included the Patient Global Impression of Improvement, stress incontinence subscale of the Pelvic Floor Distress Inventory, and Patient Satisfaction Questionnaire. Logistic regression was performed to identify predictors, adjusting for treatment and other important clinical covariates. Adjusted odds ratios (ORs), 95% confidence intervals (CIs), and associated P values are presented.ResultsFour hundred forty-six women were randomized. College education or more and no previous urinary incontinence surgery predicted success based on the stress subscale of the Pelvic Floor Distress Inventory (adjusted OR 1.61, 95% CI 1.01-2.55, P=.04 and adjusted OR 3.15, 95% CI 1.04- 9.53, P=.04, respectively). Menopausal status predicted success using the Patient Global Impression of Improvement (adjusted OR 2.52 postmenopausal compared with premenopausal, 95% CI 1.29-4.95; adjusted OR 1.32 unsure menopausal status compared with premenopausal, 95% CI 0.65-2.66; P=.03 across all three groups). Fewer than 14 incontinence episodes per week predicted satisfaction with the Patient Satisfaction Questionnaire (adjusted OR 1.97, 95% CI 1.21-3.19; P=.01). These predictors did not differ across the three treatment groups.ConclusionMenopause, higher education, no previous urinary incontinence surgery, and lower incontinence frequency were found to be predictors of success and satisfaction with nonsurgical therapy for stress urinary incontinence. This information may help better-align provider and patient expectations with nonsurgical treatment outcomes.

Project description:IntroductionUrinary incontinence (UI) is common among older men. Epidemiological studies have established many risk factors for UI but these studies are not always specific to men aged 65 and above. The literature is yet to be systematically and comprehensively reviewed to identify UI risk factors specific to these men. Such evidence is required for the development of evidence-based interventions. This scoping review will synthesise evidence regarding UI risk factors in older men.Methods and analysisThe Joanna Briggs Institute (JBI) method for scoping reviews will guide the conduct of this scoping review and its reporting alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept and Context framework is used to frame inclusion criteria, and JBI's scoping review protocol template was used to format this protocol. Our comprehensive search will include Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, Cochrane Library (via Wiley) and ProQuest Dissertations & Theses Global. There will be no language restriction since approximately 10% of preliminary search results were in languages other than English. Study type or publication date will not be restricted. Besides databases, we will review Google Scholar results and bibliographies. Two independent reviewers will screen, select and extract eligible studies. A preliminary search was performed on 24 May 2022. The search strategy and data extraction template are in online supplemental appendix. A qualitative and quantitative analysis of data will be performed as a means of describing the risk factors for UI identified among older men by using frequencies and descriptive methods.Ethics and disseminationThe review does not require ethics approval. Findings will be disseminated at conferences, in a peer-reviewed journal and used to inform the development of an evidence-based tool for self-management of UI in older men.

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Dataset Information

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions.

Purpose

Materials and methods

Results

Conclusions

Publications

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions.

Similar Datasets

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