MP65-06: Decisional Regret and Quality of Life Following Genitourinary Reconstruction: Comparing Acquired and Congenital Neurogenic Bladder with Patient-Reported Outcomes
Introduction: Patient expectations and baseline health are important drivers of outcomes following major surgery for neurogenic bladder (NGB). We hypothesize that patients with previously unaffected urinary function (i.e., acquired spinal injury) may have higher expectations for quality of life (QoL) improvement compared with those with congenital NGB. We thus aim to compare decision regret (DR) and QoL in patients undergoing urinary diversion for acquired and congenital NGB. Methods: We identified patients with spinal cord injury (SCI) or spina bifida (SB) within a NGB cohort and recorded clinical data including Charlson comorbidity index, continence, and bladder management, and obtained PROMIS-10 Global Health® questionnaire answers collected before and after diversion. The Decisional Regret Scale and SF-Qualiveen® (SFQ) forms were distributed and completed postoperatively. We compared groups with non-parametric tests for continuous variables and Fisher's exact test for categorical variables. Analysis of covariance models compared changes in outcomes by group. Results: Thirty-seven patients returned completed surveys. Groups were similar in terms of demographics and clinical characteristics. SCI patients had worse baseline physical health than SB, but postoperative changes in this score, mental health, pain level, and global QoL were not significant after adjusting for baseline scores and follow-up time. SFQ scores showed significantly worse disease-specific QoL in SCI relative to SB when adjusted for other factors. We were unable to demonstrate differences in DR scores between the two groups. Conclusions: Patients with SCI demonstrate preoperative differences in physical health when compared with those with SB, which may help urologists adequately set expectations in these different groups undergoing urinary diversion. In this small cohort, we failed to demonstrate a difference in DR, but found postoperative, urinary-specific QoL to be higher in patients with SB. SOURCE OF Funding: None.
