Characterizing patient experiences with repeat artificial urinary sphincter revisions through quantitative surveys and qualitative patient interviews

Phillip J Huffman; Gabriella Ewachiw; Ryan Johnson; Mitchell M Huang; Hasan Dani; Pedro G Knijnik; Arthur F da Silva; Arthur L Burnett; Jacek L Mostwin; Edward J Wright; Andrew J Cohen

doi:10.1177/17562872241281574

Characterizing patient experiences with repeat artificial urinary sphincter revisions through quantitative surveys and qualitative patient interviews

Ther Adv Urol. 2024 Sep 25:16:17562872241281574. doi: 10.1177/17562872241281574. eCollection 2024 Jan-Dec.

Affiliations

¹ The Brady Urological Institute at JHBMC, 4940 Eastern Avenue, 301 Building, Suite 3100, Baltimore, MD 21224, USA.
² James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Abstract

Background: Artificial urinary sphincter (AUS) placement remains the gold-standard treatment for post-prostatectomy urinary incontinence (PPUI), despite their need for periodic surgical revision.

Objective: To understand the experiences of patients who undergo repeat AUS revisions.

Design: Mixed design including quantitative surveys and qualitative interviews for thematic analysis.

Methods: Men with ⩾2 revisions were collected from a single-institution, retrospective database of AUS patients. Participants were interviewed about their prostatectomy, incontinence, AUS placement, and revisions. A survey was administered utilizing validated tools (e.g., Decision Regret Scale (DRS), Incontinence Impact Questionnaire-7) for quantitative analysis. Interview transcripts were used for qualitative thematic analysis.

Results: Of 26 respondents, 20 completed the interview. Twenty-three men completed the survey. The mean DRS score for prostatectomy was 24 (standard deviation (SD) = 27), indicating low regret. Median Incontinence Impact Questionnaire score was 54 (SD = 27), with 70% of participants describing their PPUI as "severe." Participants experienced a significant decrease in daily pad usage with AUS placement (5.5 pre-AUS vs 1.4 post-AUS, p < 0.0001). Qualitative analysis revealed themes involving prostatectomy urgency, physician-patient relationships, expectation setting, and quality of follow-up. Most participants (96%) were satisfied with their initial AUS placement and endorsed a positive relationship with their urologist. However, 22% of participants were unaware of device limitations, including the need for revision. Some participants (26%) were uncertain of the status of their AUS, while some participants (35%) desired improved follow-up.

Conclusions: Initial improvement and positive experiences with urologists motivate patients to undergo AUS repeat revision. Urologists should emphasize the limitations of the AUS before placement and follow up with patients to evaluate their needs for future care.

Keywords: AUS; post-prostatectomy urinary incontinence; qualitative; quality of life.