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JU INSIGHT Analysis of Patient Experiences Reaching Urethroplasty for Recurrent Urethral Stricture Disease
By: Abimbola Ayangbesan, MD, Vanderbilt University Medical Center, Nashville, Tennessee; George E. Koch, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Chloe Dagostino, MEd, Vanderbilt University, Nashville, Tennessee; Jack M. Proctor, BA, Vanderbilt University, Nashville, Tennessee; Helen Gambrah, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; Rohan G. Bhalla, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Kemberlee Bonnet, MA, Vanderbilt University, Nashville, Tennessee; David Schlundt, PhD, Vanderbilt University, Nashville, Tennessee; Niels V. Johnsen, MD, MPH, FACS, Vanderbilt University Medical Center, Nashville, Tennessee | Posted on: 19 Jan 2024
Ayangbesan A, Koch GE, Dagostino C, et al. Qualitative analysis of patient experiences reaching urethroplasty for recurrent urethral stricture disease. J Urol. 2024;211(1):153-162.
Study Need and Importance
While the AUA Urethral Stricture Guidelines recommend that patients who fail initial endoscopic treatment be offered urethroplasty, many patients will undergo multiple repeat endoscopic procedures. We sought to utilize qualitative methods to examine the patient experience in reaching urethroplasty and to better characterize both internal and external factors that impact a patient’s decision on care.
What We Found
Twenty patients with a history of at least 2 endoscopic procedures prior to urethroplasty participated in semistructured telephone interviews. Patients reported unmet treatment expectations with endoscopic methods, dissatisfaction with repeat procedures and frequent catheterization, and an overall negative impact that repeat symptoms and procedures had on quality of life (Figure). They further reported disappointment with treatment failures and frustration with the lack of counseling regarding available alternative options. While external factors such as financial, travel, and work-related concerns all played a role in delaying urethroplasty, patients reported significant improvements in quality of life following urethroplasty and wished they had proceeded to definitive therapy earlier in their clinical trajectory.
Limitations
This study is limited to a select, geographically distinct sample of patients and may not be nationally representative. However, it provides insight into how patients experience urethral stricture disease and associated care. This study does not address outcomes in patients who had either complications from urethroplasty or subsequent recurrent strictures, which will likely impact patient-reported experiences.
Interpretation for Patient Care
There are provider and patient factors, both internal and external, that influence the trajectory of care that patients receive for recurrent urethral stricture disease. Not all patients will be interested in proceeding with early urethroplasty, but these data show that patients prefer appropriate counseling about care options and that repeat endoscopic care is often associated with a subjective decrease in quality of life.
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