When seeking treatment for male SUI (mSUI), patients are faced with weighing complex risks and benefits in making treatment decisions within their individual context. We sought to quantify the frequency of decisional regret among this population and to determine factors associated with regret.
A cohort of 130 males aged≥65 seen for initial mSUI consultation at the University of California, San Francisco Medical Center and the San Francisco Veterans Affairs Medical Center between June 2015-March 2020 was developed. Using retrospective chart review and telephone interviews, we ascertained decisional regret as well as other patient-, disease-, and treatment-related characteristics. Decisional regret was analyzed by treatment type and patient-, disease-, and treatment-related factors. Multivariable logistic regression models were built to examine the factors most associated with decisional regret.
Among the entire cohort, 22% reported moderate to severe decisional regret. Regret was highest among those electing conservative management, with 34.7% having decisional regret (vs. with surgery: 8.3% sling, 8.2% sphincter, p <0.001). In multivariable analysis, depression, lower rating of shared decision-making, and higher current incontinence scores were significantly associated with decisional regret.
Recognition of depression, improved efforts at shared decision-making, and more individualized treatment counseling have the potential to improve patient satisfaction with treatment choice. In addition, given high levels of regret among those electing conservative treatment, we may be underutilizing mSUI surgery in this population.
The Journal of urology. 2021 Dec 02 [Epub ahead of print]
Lindsay A Hampson, Anne M Suskind, Benjamin N Breyer, Matthew R Cooperberg, Rebecca L Sudore, Salomeh Keyhani, I Elaine Allen, Louise C Walter
Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California., Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California., Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California.