Caution with Use of the EPIC-50 Urinary Bother Scale: How Voiding Dysfunction Modifies its Performance

Abstract

Purpose We evaluated the agreement between patient-reported urinary function and bother, and sexual function and bother in radical prostatectomy (RP) patients to help inform possible non-functional, modifiable mechanisms for patient bother. Methods Patients were recruited from 2011-2014 at Washington University and Brigham & Women's Hospital. Urinary and sexual outcomes were assessed by the Expanded Prostate Cancer Index Composite-50 (EPIC-50) before, five weeks, and 12 months after RP. Spearman rank correlation coefficients and agreement/disagreement categories were used to describe the relation between function and bother. Results Despite moderate to good agreement between function and bother (urinary: r=0.51-0.69; sexual: r=0.65-0.80), discordant groups were observed. In the urinary domain, these groups were men disproportionately bothered by their function at baseline (16.9%) and 12 months post-RP (6.1%), and men less bothered by their function 5 weeks (26.8%) and 12 months post-RP (9.9%). Discordant groups in the sexual domain were men less bothered by their function at baseline (20.8%), 5 weeks (21.1%), and 12 months (15.7%) post-RP. Splitting the urinary bother scale into two sub-scales, one for incontinence-related bother to compliment the urinary function scale, which measures only incontinence, and one for voiding dysfunction-related bother, yielded considerably better agreement (r=0.78-0.83 for urinary function and incontinence-related bother). Factors contributing to the group less bothered by their sexual function were unclear. Conclusions When using the EPIC-50, investigators should consider splitting the urinary bother scale by relation to incontinence to prevent distortion of function/bother and pre-/post-RP comparisons by co-existing voiding dysfunction.

Effectiveness and Prognosis: Drainage Skin-Bridge Sparing Surgery Combined with Fistulotomy versus Fistulotomy Only in the Treatment of Anal Fistula

“…Voiding function [ 15 ] was assessed on a scale of 0–3. Score 0: could urine on its own after surgery without any assistance, score 1: could urine only when listening to the sound of running water or applying heat to the bladder, score 2: only could urine smoothly with medication (neostigmine intramuscular), score 3: catheterization is required.…”

One-year urinary and sexual outcome trajectories among prostate cancer patients treated by radical prostatectomy: a prospective study

“…This validated scale includes sub-scales for urinary function (i.e., continence), urinary bother, sexual function, and sexual bother. We split the urinary bother scale into two sub-scales to distinguish incontinence-related bother from voiding dysfunction-related bother [ 16 ]. For each EPIC-50 sub-scale, a summary score was calculated and then transformed linearly to a 0-to-100 scale, with higher scores indicating better function and less bother.…”

“…The upper bounds of these sub-scale-specific ranges were chosen to obtain conservative estimates: i.e., 9 point change in the urinary domain (7 for voiding dysfunction-related symptoms) and 12-point change in the sexual domain [ 17 ]. We used these sub-scale-specific values to create the following categories of change: improved beyond baseline (positive change greater than the MCID), maintained (within the positive to negative values of the MCID), and impaired below baseline (negative change greater than the MCID) [ 16 , 18 ]. We also used the lower bounds of sub-scale-specific ranges to classify participants in sensitivity analyses.…”