Departamento Clínico, Hospital Universitario de Getafe, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Carretera de Toledo Km 12.5, Getafe, 28905, Madrid, Spain.
Hospital Alvaro Cunqueiro, Vigo, Spain.
World J Urol. 2019 Oct;37(10):2189-2197. doi: 10.1007/s00345-019-02639-4. Epub 2019 Jan 16.
Patient-reported outcome measurements are important for urinary incontinence. We analyze self-assessed patient satisfaction and define the clinical profile of patient with highest satisfaction with the adjustable transobturator male system (ATOMS).
Patient perception of results was evaluated in a series of 181 patients after ATOMS adjustment. Baseline incontinence severity was defined in pads-per-day (PPD) as mild (2), moderate (3-5) or severe (≥ 6), and dryness as use of none or one security PPD. Post-operative pain at discharge was evaluated by 0-10 visual analogue scale and complications by Clavien-Dindo classification. Multivariate analysis was performed to anticipate "very much better" than baseline perception on patient global impression of improvement and a predictive nomogram was developed.
Dryness was achieved in 80.7% (94.9% mild, 80.8% moderate and 65.8% severe groups). Mean pad-test and pad-count decrease with respect to baseline was 458 ± 330 ml and 3.2 ± 1.9 PPD, respectively (both p < .0001). Complications presented in 25 (13.8%). The proportion of patients that self-declared satisfied with the procedure was 87.1%; 90.6% perceived their situation "better" and 48.1% "very much better" than before. Multivariate analysis revealed best perception is defined by dryness after adjustment (p < .0001), baseline severity of incontinence (p = .007), low post-operative pain at discharge (p = .0018) and lack of complications (p = .007).
Self-assessed satisfaction with ATOMS is very high. Factors that predict best perception of improvement include dryness, baseline SUI severity, presence of complications and pain level during admission. Radiotherapy and device generation were not independent predictors. A nomogram to predict patients that are completely satisfied with ATOMS after adjustment is proposed.
患者报告的结局测量对尿失禁很重要。我们分析了患者的自我满意度，并确定了对可调经闭孔男性系统（ATOMS）满意度最高的患者的临床特征。
在对 181 例 ATOMS 调整后的患者进行一系列评估中，评估了患者对结果的感知。失禁严重程度根据垫数/天（PPD）定义为轻度（2）、中度（3-5）或重度（≥6），干燥程度定义为使用无或一个安全垫的 PPD。出院时的术后疼痛通过 0-10 视觉模拟量表进行评估，并发症通过 Clavien-Dindo 分类进行评估。进行多变量分析以预测患者整体改善感知的“明显优于基线”，并开发了预测列线图。
80.7%（94.9%轻度、80.8%中度和 65.8%重度组）实现了干燥。与基线相比，垫试验和垫计数分别减少了 458±330ml 和 3.2±1.9 PPD（均 p<0.0001）。25 例（13.8%）出现并发症。自我报告对手术满意的患者比例为 87.1%；90.6%的患者认为自己的情况“更好”，48.1%的患者认为自己的情况“明显更好”。多变量分析显示，调整后的干燥（p<0.0001）、失禁基线严重程度（p=0.007）、出院时低术后疼痛（p=0.0018）和无并发症（p=0.007）是最佳感知的最佳预测因素。
对 ATOMS 的自我评估满意度非常高。预测改善感知最佳的因素包括干燥、基线 SUI 严重程度、并发症的存在和入院期间的疼痛水平。放射治疗和设备的更新换代不是独立的预测因素。提出了一个预测患者在调整后对 ATOMS 完全满意的列线图。
