Factors Influencing Patient Preference for Treatment of Stress Incontinence

Objectives: To determine procedure-specific factors that influence patient decision-making when choosing treatment for stress urinary incontinence (SUI).

Methods: This was a cross-sectional survey study of patients presenting with bothersome SUI at a tertiary care referral center. Patients were invited to complete an anonymous survey about their SUI treatment preferences if they initially reported bothersome SUI on the PFDI-20 prior to being seen for a new patient visit at our urogynecology clinic. Those who agreed to participate were included in the study. A convenience sample of 100 patients was obtained in order to answer our study question.

Results: 100 surveys were included in the analysis. The mean age of the cohort was 57.1±13.6 years and 85 patients were white, 47 were employed full-time, and 50 patients had received a bachelor’s degree or higher. A total of 33 and 9 patients were familiar with either midurethral sling (MUS) and/or urethral bulking (UB), respectively. Of the 33 patients familiar with MUS, 25 (75.8%) had either negative or unsure feelings about the procedure. In contrast, 4 patients out of 9 (44.4%) reported similar feelings for UB. The top three influential factors in choosing the type of intervention for SUI were procedure success rate (72%), amount of research available on procedure (52%), and chance of needing retreatment for SUI (34%). UB was favored in almost every procedure-specific category (wait time, pain medications, days off work, need for anesthesia, chance of catheter, and risk of abnormal voiding and/or mesh exposure); however, MUS was favored in the categories of amount of research performed on the intervention and known research outcomes. At the end of the survey, 51 patients responded that they were more likely to choose a MUS as their intervention of choice, while 39 were more likely to undergo UB, and 10 were equally as likely to undergo either procedure. Patients in all three response groups did not differ in age, race, employment status or education. In patients that preferred MUS, the top three influential factors were amount of research on procedure (66.7%), chance of needing retreatment for SUI (35.3%), and procedure location (such as operating room or clinic) (21.6%). A sub-analysis was done removing the patients who had pre-visit knowledge about MUS and/or UB (n=64) and UB remained the favored approach in all categories with the exception of research outcomes, and MUS still remained the favored approach overall when it came time to choose a single preferred intervention.

Conclusions: Patient preferences for UB versus MUS differed depending upon the information provided to patients about each intervention. There was heterogeneity in patient preferences, with MUS ultimately favored by more patients.