Northwestern University - The Feinberg School of Medicine
Introduction: Patient perspectives regarding clinical conditions and the influence of treatments are essential to patient-centered care. We aimed to evaluate patient-reported outcomes regarding experiences, symptoms, and impacts of ureteral stricture disease (USD) and robotic ureteral reconstruction (RUR). Methods: Patients undergoing RUR for USD between 9/2021 and 9/2022 were eligible for enrollment. Semi-structured concept elicitation interviews were conducted to evaluate the physical, mental, and social effects of USD at three stages: 1. Preoperative, 2. Postoperative recovery (with ureteral stent), 3. Postoperative recovery (after stent removal). Concerning symptoms related to USD, patients rated symptom bother from 0 (none) to 10 (extreme). We conducted interviews until concept saturation was achieved and no new information was gained. Interviews were transcribed, coded, and qualitatively analyzed. Results: Concept saturation was reached after 14 interviews. In the preoperative phase, flank pain (10/14 [71%]) and urinary urgency (6/14 [42%]) were the most common symptoms. All patients with urinary urgency had a ureteral stent during the preoperative phase. The median (IQR) preoperative bother scores of flank pain and urinary urgency were 8.5 (6.6-10) and 9.0 (5.8-10), respectively. The most common themes were emotional distress to symptoms (10/14 [71]%) and social/occupational impairment (9/14 [64]%). The most common factors that influenced a patient’s decision to undergo RUR were renal function preservation (8/14 [57]%), and the desire to remove hardware (i.e., nephrostomy tubes and ureteral stents) (8/8 [100]% who had presurgical hardware). During postoperative recovery, urinary urgency (8/14 [57%]) and flank pain (5/14 [35%]) were the most common symptoms. The median (IQR) postoperative recovery phase bother scores of flank pain and urinary urgency were 8.0 (4.0-8.0) and 6.0 (5.8-9.0), respectively. In the postoperative recovery phase, 1/14 (7%) reported intermittent flank pain (bother = 4). All patients reported a “successful surgery.” Patients most commonly described surgical success as complete symptom relief (8/14 [57%]). Conclusions: Flank pain and urinary urgency (related to ureteral stent) were the most bothersome symptoms in the preoperative phase. Renal function preservation and the desire to remove hardware were the most common factors that influenced patients to undergo RUR. Symptom relief was the most commonly described determinant of patient-perceived surgical success. SOURCE OF Funding: None
