Surgical Treatment Preference for Management of Vesicoureteral Reflux - A Survey of 524 Respondents
Michael Garcia-Roig, MD1, Curtis Travers, MPH2, Courtney McCracken, PhD2, Jared Kirsch, BA1, Andrew J. Kirsch, MD1.
1Emory University and Childrens Healthcare of Atlanta, Atlanta, GA, USA, 2Department of Pediatrics - Biostatistics Core, Emory University, Atlanta, GA, USA.
Introduction: Choice of surgical treatment option for vesicoureteral reflux (VUR) requires a discussion of available procedure details and their relative success rates with caregivers. We evaluated the choices individuals would make for themselves as children and their children regarding surgical treatment options for VUR. We hypothesized individuals would prefer hidden or no incisions in favor of a potentially more successful procedure.
Methods: A survey was generated assessing individual's preference for surgical approach including the available treatment modalities for VUR: endoscopic correction (EC), robot-assisted ureteral reimplantation (RALUR), hidden incision (HIdES) RALUR, and open (Pfannenstiel) ureteral reimplantation. Additional questions assessed the impact of postoperative hospital stay, pain, well-healed barely visible incision, and relative surgical success rate (Pfannenstiel "95% success;" RALUR, HIdES, and EC "80% success"). Respondents were informed that a failed procedure may require repeat surgery. The survey was posted to Amazon Mechanical Turk (www.mturk.com) with a $0.20 reward/completed survey. Non-identifying demographic information was assessed. Responses were excluded if 4 attention confirming questions/tasks were not completed correctly.
Results: A total of 1,050 surveys were collected. We excluded 175 incomplete, and 351 with incorrect attention tasks, leaving 524 completed surveys for analysis. Participants had the following demographics being most prevalent: male gender 342(65.3%), US resident 266 (50.8%), age 25-34 years old 244 (46.6%), white race 262 (50.0%), bachelor's degree or above 371 (71.2%), married 271 (52.0%), have children 237 (54.4%). A history of surgery was reported in 249 (47.5%), and in childhood 111/524 (21.2%) with scar bother reported by 106/249 (42.6%). Detailed surgical approach responses and the impact of each question on original incision choice are outlined in the Table; questions were presented in the order listed in the Table. Based on surgical approach and scar location alone, EC was initially the most commonly chosen approach by 175 (33.4%). When shown incisions relative to underwear, 47 of 65 (72.3%) initially choosing RALUR chose a different incision. Of those initially choosing Pfannenstiel (n=114), 60 (51.7%) would not change their choice if it meant less pain or shorter hospital stay. The relative success rate of individual procedures resulted in the largest impact on change in surgical approach, with 312 (59.5%) choosing the highest success procedure (Pfannenstiel). This represents an increase of 229%-273% for this surgical approach relative to previous questions when surgical success rate was not disclosed.
Conclusion: Discussion of surgical treatment options for correction of VUR should include a discussion of surgical scar location and size, and a discussion of relative success rates of each approach. Although limited by lack of quoted postop UTI rates, our survey demonstrates several factors affect patient decision-making in surgical treatment, with relative success rate of the procedure having the highest impact.
|Question 1||Question 2||Question 3||Question 4|
|Surgery Preference||Primary Preference||Some of the incisions hidden below the underwear line||Good chance the scar would be hardly noticeable||Success rate described|
|Pfannenstiel||114 (21.8%)||149 (28.4%)||144 (27.5%)||341 (65.1%)|
|RALUR||65 (12.4%)||28 (5.3%)||47 (9.0%)||21 (4.0%)|
|HIdES RALUR||114 (21.8%)||130 (24.8%)||169 (32.3%)||52 (9.9%)|
|Endoscopic Correction||175 (33.4%)||168 (32.1%)||109 (20.8%)||78 (14.9%)|
|No preference||56 (10.7%)||49 (9.4%)||55 (10.5%)||32 (6.1%)|
|Did not change original preference||-||363 (69.3%)||303 (57.8%)||230 (43.9%)|
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