Chung Paul H, Vanni Alex J, Breyer Benjamin N, Erickson Bradley A, Myers Jeremy B, Alsikafi Nejd, Buckley Jill, Elliott Sean P, Zhao Lee C, Voelzke Bryan B
Department of Urology, Thomas Jefferson University, Philadelphia, PA.
Department of Urology, Lahey Clinic, Burlington, MA.
Urology. 2019 Apr;126:222-226. doi: 10.1016/j.urology.2018.12.009. Epub 2018 Dec 20.
To compare the utility of generic health quality of life (QOL) and condition specific indicators as patient reported outcomes measures for urethral stricture surgery.
Patient data were obtained from the Trauma and Urologic Reconstructive Network of Surgeons collaborative database. Patients who underwent any successful urethroplasty and completed both pre- and postoperative generic and condition-specific questionnaires were included.
A total of 201 patients met inclusion criteria. Urethral-stricture specific measures improved after surgery: mean LUTS score (13.1-4.0, p<0.05), Peeling curve (3.1-1.7, p < 0.05), and overall interference of urinary symptoms on life (3.0-1.6, p < 0.05). Mean overall health status visual analog scale (74.2-80.0, p < 0.05) and generic health QOL EQ-5D index scores (0.90-0.95, p < 0.05) also improved; however, individual EQ-5D measures assessing mobility, self-care, and activity level did not change. EQ-5D measures for pain/discomfort (1.48-1.23, p < 0.05) and anxiety/depression (1.33-1.21, p < 0.05) improved, but not to the same extent as stricture-specific measures. More patients reported improvement in condition-specific urethra/penis pain and bladder pain compared to improvement in generic EQ-5D pain/discomfort (p < 0.001).
Generic health QOL indicators are less meaningful in the assessment of urethral stricture surgery and should be replaced with condition-specific outcomes measures. It is important to ensure that appropriate condition-specific outcomes measures are utilized as patient reported outcomes measures become more prevalent in medicine and potentially become utilized to evaluate surgeon outcomes and determine surgeon reimbursement.
比较一般健康生活质量（QOL）指标和特定疾病指标作为患者报告的尿道狭窄手术结局指标的效用。
患者数据来自外科医生创伤与泌尿外科重建网络协作数据库。纳入接受任何成功尿道成形术并在术前和术后完成一般及特定疾病问卷的患者。
共有201例患者符合纳入标准。术后尿道狭窄特异性指标有所改善：平均下尿路症状评分（13.1 - 4.0，p<0.05）、剥脱曲线（3.1 - 1.7，p < 0.05）以及尿路症状对生活的总体干扰（3.0 - 1.6，p < 0.05）。平均总体健康状况视觉模拟量表（74.2 - 80.0，p < 0.05）和一般健康QOL的EQ - 5D指数评分（0.90 - 0.95，p < 0.05）也有所改善；然而，评估活动能力、自我护理和活动水平的个体EQ - 5D指标未发生变化。疼痛/不适（1.48 - 1.23，p < 0.05）和焦虑/抑郁（1.33 - 1.21，p < 0.05）的EQ - 5D指标有所改善，但改善程度不如狭窄特异性指标。与一般EQ - 5D疼痛/不适的改善相比，更多患者报告特定疾病的尿道/阴茎疼痛和膀胱疼痛有所改善（p < 0.001）。
一般健康QOL指标在评估尿道狭窄手术中意义较小，应以特定疾病结局指标取而代之。随着患者报告的结局指标在医学中越来越普遍，并可能用于评估外科医生的手术结局和确定外科医生的报销情况，确保使用适当的特定疾病结局指标非常重要。
