Understanding the Health Characteristics and Treatment Choices of Older Men with Stress Urinary Incontinence

Hampson, Lindsay A.; Suskind, Anne M.; Breyer, Benjamin N.; Lai, Lillian Y.; Cooperberg, Matthew R.; Sudore, Rebecca L.; Keyhani, Salomeh; Allen, I. Elaine; Walter, Louise C.

doi:10.1016/j.urology.2021.05.002

Cited by 9 publications

(12 citation statements)

References 33 publications

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“…Methods have been described in detail previously and are summarized here. 9 A total of 186 men age ≥65 years at the University of California, San Francisco and the San Francisco Veterans Affairs Healthcare System underwent consultation for mSUI between June 2015 and March 2020 and were recruited to participate in the study. We recruited participants by phone, using electronic medical record review and a telephone survey to assess various characteristics among those who consented.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Methodsmentioning

confidence: 99%

“…5 Adding to the complexity of treatment decisions, data show that patients and their providers are faced with weighing these risks and benefits within the context of existing multimorbidity, frailty and functional limitations, and limited life expectancy. 9…”

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

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“…Study participants' demographic, clinical and patientreported outcome measures (PROMs) were abstracted from the previously published quantitative cohort (11). For this analysis, only those with complete objective data on frailty, number of pads per day, and treatment choice were included.…”

Section: Quantitative Data Collectionmentioning

confidence: 99%

“…In addition, frailty has been found to be associated with common urologic conditions such as recurrent urinary tract infections, overactive bladder, male lower urinary tract symptoms, as well as associated with higher rates of complications among common urologic procedures (5)(6)(7)(8)(9)(10). Among men seeking evaluation for SUI, in particular, one cohort study found that 22.3% are frail or pre-frail, with rates of frailty at 40% for those undergoing artificial sphincter placement (11). Another study using National Surgical Quality Improvement Program data showed that 6.1% of individuals undergoing AUS placement were frail, and 12.9% of those undergoing AUS removal were frail (12).…”

Section: Introductionmentioning

confidence: 99%

“…Understanding patients' views of the impact of frailty and incontinence severity on SUI decision-making is important to help guide improved treatment decisions to ensure that the patient voice is being incorporated in this process. To this end, herein we evaluate a subset of a previously published SUI cohort, employing mixed methodology to analyze participants with quantitative frailty data and qualitatively examine the relationship between frailty, incontinence severity and SUI treatment decisions from the patient's perspective (11). We hypothesize that frailty and medical comorbidity may lead men to avoid surgery even in the setting of high incontinence severity.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between frailty, incontinence severity, and treatment decisions for men with post-prostatectomy stress urinary incontinence: a mixed methods analysis

Jones¹,

Shaw²,

Mena³

et al. 2023

Transl Androl Urol

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Background: Frailty 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. Methods:We 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.Results: Among 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. Conclusions:The 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.

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How older men live with stress urinary incontinence: Patient experience and navigation to treatment

Shaw,

Breyer,

Walter

et al. 2023

Neurourology and Urodynamics

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ObjectivesTo explore the context in which older men navigate treatment for stress urinary incontinence (SUI) following prostate surgery by characterizing lived experience of men with symptomatic SUI.Subjects/Patients and MethodsMixed method study using surveys and semistructured interviews to examine a cohort of men who underwent evaluation for treatment of postprostatectomy SUI.ResultsThirty‐six men were interviewed after consultation for SUI and 31 had complete quantitative clinical data. Twenty‐six underwent surgery and 10 chose no surgical intervention. In qualitative interviews, respondents experienced substantial decline in quality of life due to incontinence citing concerns associated with use of pads and worrying about incontinence. Most patients reported “workarounds”—efforts to mitigate or manage incontinence including Kegels, physical therapy, and garments. Participants also reported lifestyle changes including less strenuous physical activity, less sexual activity, and/or fewer social gatherings. Patients then described a “breaking point” where incontinence workarounds were no longer sufficient. After seeking evaluation, men described challenges in exploring treatment for SUI, including access to care and provider knowledge of treatment options.ConclusionIn a novel study of patients living with SUI a predictable lived experience was observed that culminated in a desire for change or “breaking point.” In all men, this led to treatment‐seeking behaviors and for many it led to SUI intervention. Despite effective treatments, patients continue to meet barriers gaining access to SUI evaluation and treatment.

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Understanding the Health Characteristics and Treatment Choices of Older Men with Stress Urinary Incontinence

Cited by 9 publications

References 33 publications

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

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

The relationship between frailty, incontinence severity, and treatment decisions for men with post-prostatectomy stress urinary incontinence: a mixed methods analysis

How older men live with stress urinary incontinence: Patient experience and navigation to treatment

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