Patients’ perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence

Abstract

Introduction and hypothesisThe aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option.MethodsIn a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers.ResultsSixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed ‘becoming dry’ was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option.ConclusionPatients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.

How cure rates drive patients' preference for urethral bulking agent or mid‐urethral sling surgery as therapy for stress urinary incontinence

“…Thus, apart from the invasiveness, type of anesthesia and setting, other motives are taken into account when selecting a treatment option for SUI. This is in keeping with the results of a qualitative interview study we performed, where we identified 16 treatment‐decision factors influencing the patients preference for UBA or MUS surgery …”

“…This is in keeping with the results of a qualitative interview study we performed, where we identified 16 treatment-decision factors influencing the patients preference for UBA or MUS surgery. 18 In our study, we did not find any strong correlations between patients characteristics and the preference for UBA or MUS surgery. Although patients with longer existing SUI symptoms were more likely to have a lower median-accepted threshold of cure rate, the correlation 19).…”

Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI‐RS 2018

“…A patient's decision to proceed with a particular management option for SUI is influenced by a number of factors. Procedural factors include efficacy and complication rates, length of stay, recovery time, level of invasiveness, type of anesthesia, and long‐term outcomes . However, these procedural factors are only one aspect that patients consider when making a decision.…”

“…However, these procedural factors are only one aspect that patients consider when making a decision. Other important determinants include personal factors (perceived severity of symptoms, age, previous experience with anesthesia or surgery), professional factors (experience of the surgeon, advice from other medical practitioners), societal factors (advice of family and friends, media reporting), and external factors (cost) . In addition, patients also make their choice depending on their own expectations and goals related to outcome…”

“…Procedural factors include efficacy and complication rates, length of stay, recovery time, level of invasiveness, type of anesthesia, and long-term outcomes. 46 However, these procedural factors are only one aspect that patients consider when making a decision. Other important determinants include personal factors (perceived severity of symptoms, age, previous experience with anesthesia or surgery), professional factors (experience of the surgeon, advice from other medical practitioners), societal factors (advice of family and friends, media reporting), and external factors (cost).…”