Ghidini Filippo, Sekulovic Sasa, Castagnetti Marco
Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
J Urol. 2016 Mar;195(3):720-4. doi: 10.1016/j.juro.2015.10.118. Epub 2015 Oct 27.
Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes.
Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents.
Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup.
Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients.
决策性遗憾被定义为做出医疗保健选择后的苦恼，对于为儿子选择远端尿道下裂修复术的父母来说可能是个问题。我们评估了与家庭、手术和结果相关的变量对决策性遗憾的影响。
回顾了2005年至2012年间372例接受原发性远端尿道下裂修复术患者的病历，并向家长发放了经过验证的问卷，包括决策性遗憾量表、小儿阴茎感知评分以及排尿功能障碍和尿失禁评分系统。
372个家庭中有172个家庭提供了数据（回复率46.2%）。在323名家长中，128名（39.6%）表现出中度强烈的决策性遗憾，夫妻之间意见高度一致。决策性遗憾的预测因素包括父母教育水平中等（比值比3.19，95%置信区间1.52 - 6.69）、患者非头胎（比值比2.01，95%置信区间1.07 - 3.78）、尿道下裂家族史（比值比4.42，95%置信区间1.96 - 9.97）、最初希望避免手术（比值比2.07，95%置信区间1.04 - 4.12）、随访时年龄较小（比值比0.81，95%置信区间0.72 - 0.91）、存在下尿路症状（比值比4.92，95%置信区间1.53 - 15.81）以及小儿阴茎感知评分较低（比值比0.86，95%置信区间0.75 - 0.99）。决策性遗憾与父母希望避免包皮环切术、手术变量、并发症的发生以及随访时间无关。
对于为儿子选择远端尿道下裂修复术的相当一部分父母来说，决策性遗憾是个问题。根据我们的经验，家庭变量似乎是决策性遗憾的预测因素，而手术变量则不是。决策性遗憾的预测因素包括父母对阴茎外观的较差感知以及存在下尿路症状。然而，后者可能与手术无关。无论随访时间长短，年龄较大患者的父母的决策性遗憾似乎有所减少。
