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Are patients willing to trade cure rate against less pain? Patients’ preferences for single incision midurethral sling or transobturator standard midurethral sling
Author(s) -
Schellart René P.,
Casteleijn Fenne M.,
Dijkgraaf Marcel G. W.,
Tutolo Manuela,
Roovers JanPaul W. R.
Publication year - 2017
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23093
Subject(s) - medicine , sling (weapon) , surgery , groin , urinary incontinence , cure rate , urinary retention , confidence interval
AIMS To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single‐incision mini‐sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS). METHODS A multi‐center, interview‐based trade‐off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade‐off was assessed for two hypothetical durations of substantial postoperative pain after SMUS—2 days or 2 weeks—while simultaneously assuming the absence of substantial postoperative pain after SIMS. RESULTS To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women ( P = 0.04) and single women ( P = 0.04) were associated with the trade‐off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade‐off limits were found for patients’ actual severity, duration, and frequency of SUI. CONCLUSIONS Patients are willing to accept a slightly lower probability of cure to prevent substantial post‐operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.