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Understanding patients’ preferences for surgical management of urethral stricture disease

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference.

Patients and methods

Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata.

Results

169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals.

Conclusion

These results can help to inform physicians’ counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.

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References

  1. Santucci RA, Joyce GF, Wise M (2007) Male urethral stricture disease. J Urol 177:1667–1674. doi:10.1016/j.juro.2007.01.041

    Article  PubMed  Google Scholar 

  2. Bertrand LA, Bertrand LA, Warren GJ et al (2015) Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction. J Urol 193:184–189. doi:10.1016/j.juro.2014.07.007

    Article  PubMed  Google Scholar 

  3. Rourke K, Rourke K, Hickle J, Hickle J (2012) The clinical spectrum of the presenting signs and symptoms of anterior urethral stricture: detailed analysis of a single institutional cohort. Urology 79:1163–1167. doi:10.1016/j.urology.2012.01.044

    Article  PubMed  Google Scholar 

  4. Nuss GR, Granieri MA, Zhao LC et al (2012) Presenting symptoms of anterior urethral stricture disease: a disease specific, patient reported questionnaire to measure outcomes. J Urol 187:559–562. doi:10.1016/j.juro.2011.10.043

    Article  PubMed  Google Scholar 

  5. Jackson MJ, Jackson MJ, Chaudhury I et al (2013) A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol 64:777–782. doi:10.1016/j.eururo.2013.04.037

    Article  PubMed  Google Scholar 

  6. Hampson LA, McAninch JW, Breyer BN (2014) Male urethral strictures and their management. Nat Rev Urol 11:43–50. doi:10.1038/nrurol.2013.275

    Article  PubMed  Google Scholar 

  7. Pignone MP, Brenner AT, Hawley S et al (2012) Conjoint analysis versus rating and ranking for values elicitation and clarification in colorectal cancer screening. J Gen Intern Med 27:45–50. doi:10.1007/s11606-011-1837-z

    Article  PubMed  Google Scholar 

  8. Bridges JFP, Mohamed AF, Finnern HW et al (2012) Patients’ preferences for treatment outcomes for advanced non-small cell lung cancer: a conjoint analysis. Lung Cancer 77:224–231. doi:10.1016/j.lungcan.2012.01.016

    Article  PubMed  Google Scholar 

  9. Wouters H, Maatman GA, Van Dijk L et al (2013) Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer. Ann Oncol 24:2324–2329. doi:10.1093/annonc/mdt195

    Article  CAS  PubMed  Google Scholar 

  10. Johnson FR, Hauber AB, Ozdemir S, Lynd L (2010) Quantifying women’s stated benefit-risk trade-off preferences for IBS treatment outcomes. Value Health 13:418–423. doi:10.1111/j.1524-4733.2010.00694.x

    Article  PubMed  Google Scholar 

  11. Silverman S, Calderon A, Kaw K et al (2013) Patient weighting of osteoporosis medication attributes across racial and ethnic groups: a study of osteoporosis medication preferences using conjoint analysis. Osteoporos Int 24:2067–2077. doi:10.1007/s00198-012-2241-1

    Article  CAS  PubMed  Google Scholar 

  12. Hampson LA, Allen IE, Gaither TW et al (2017) Patient-centered treatment decisions for urethral stricture: conjoint analysis improves surgical decision-making. Urology 99:246–253. doi:10.1016/j.urology.2016.07.053

    Article  PubMed  Google Scholar 

  13. Wilson L, Lin TK, Hampson LA et al (2017) Use of conjoint analysis to determine patient preferences for surgical treatment of urethral stricture disease. J Particip Med 9:e1

    Google Scholar 

  14. Pansadoro V, Emiliozzi P (1996) Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol 156:73–75. doi:10.1016/S0022-5347(01)65942-1

    Article  CAS  PubMed  Google Scholar 

  15. Greenwell TJ, Castle C, Andrich DE et al (2004) Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol 172:275–277. doi:10.1097/01.ju.0000132156.76403.8f

    Article  CAS  PubMed  Google Scholar 

  16. Tinaut-Ranera J, Arrabal-Polo MÁ, Merino-Salas S et al (2014) Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty. Can Urol Assoc J 8:E16. doi:10.5489/cuaj.1407

    Article  PubMed  PubMed Central  Google Scholar 

  17. Anger JT, Buckley JC, Santucci RA et al (2011) Trends in stricture management among male medicare beneficiaries: underuse of urethroplasty? Urology 77:481–485. doi:10.1016/j.urology.2010.05.055

    Article  PubMed  Google Scholar 

  18. van Leeuwen MA, Brandenburg JJ, Kok ET et al (2011) Management of adult anterior urethral stricture disease: nationwide survey among urologists in the Netherlands. Eur Urol 60:159–166. doi:10.1016/j.eururo.2011.03.016

    Article  PubMed  Google Scholar 

  19. Bullock TL, Brandes SB (2007) Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol 177:685–690. doi:10.1016/j.juro.2006.09.052

    Article  PubMed  Google Scholar 

  20. Wessells H, Angermeier KW, Elliott SP et al (2016) Male urethral stricture: American urological association. J Urol 197(1):182–190

    Article  PubMed  Google Scholar 

  21. Wright JL, Wright JL, Wessells H et al (2006) What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis. Urology 67:889–893. doi:10.1016/j.urology.2005.11.003

    Article  PubMed  Google Scholar 

  22. Rourke KF, Jordan GH (2005) Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol 173:1206–1210. doi:10.1097/01.ju.0000154971.05286.81

    Article  PubMed  Google Scholar 

  23. Lacy JM, Cavallini M, Bylund JR et al (2014) Trends in the management of male urethral stricture disease in the veteran population. Urology 84:1506–1509. doi:10.1016/j.urology.2014.06.086

    Article  PubMed  Google Scholar 

  24. Burks FN, Salmon SA, Smith AC, Santucci RA (2012) Urethroplasty: a geographic disparity in care. J Urol 187:2124–2127. doi:10.1016/j.juro.2012.01.078

    Article  PubMed  Google Scholar 

  25. Kessler TM, Fisch M, Heitz M et al (2002) Patient satisfaction with the outcome of surgery for urethral stricture. J Urol 167:2507–2511

    Article  PubMed  Google Scholar 

  26. Santucci RA, McAninch JW, Mario LA et al (2004) Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications. J Urol 172:201–203. doi:10.1097/01.ju.0000128810.86535.be

    Article  PubMed  Google Scholar 

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Acknowledgements

Financial support for this study was provided in part by Grants from NIDDK/NIH K12DK083021, the California Urology Foundation and the UCSF CTSI Resident Research Funding grant. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report.

Author’s contributions

LAH: project development, data collection/management, data analysis, and manuscript writing. TKL: data analysis and manuscript editing. LW: project development, data analysis, and manuscript editing. IEA: data analysis and manuscript editing. TWG: data collection and manuscript editing. BNB: project development and manuscript editing.

Author information

Authors and Affiliations

  1. Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA

    Lindsay A. Hampson & Benjamin N. Breyer

  2. Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA

    Tracy K. Lin & Leslie Wilson

  3. Department of Epidemiology and Biostatistics, UCSF School of Medicine, San Francisco, USA

    Isabel E. Allen

  4. UCSF School of Medicine, San Francisco, USA

    Thomas W. Gaither

Authors
  1. Lindsay A. Hampson
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  2. Tracy K. Lin
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  3. Leslie Wilson
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  4. Isabel E. Allen
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  5. Thomas W. Gaither
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  6. Benjamin N. Breyer
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Corresponding author

Correspondence to Lindsay A. Hampson.

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Conflict of interest

None of the authors have conflict of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hampson, L.A., Lin, T.K., Wilson, L. et al. Understanding patients’ preferences for surgical management of urethral stricture disease. World J Urol 35, 1799–1805 (2017). https://doi.org/10.1007/s00345-017-2066-9

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  • DOI: https://doi.org/10.1007/s00345-017-2066-9

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