Editorial Comment

Abstract

Choice-based conjoint analysis has the potential to be a valuable decision-making tool for patients faced with urethral stricture disease, and the results of this study are encouraging. 1 Hampson L.A. Allen I.E. Gaither T.W. et al. Patient-centered treatment decisions for urethral stricture: conjoint analysis improves surgical decision-making. Urology. 2016; https://doi.org/10.1016/j.urology.2016.07.053 Abstract Full Text Full Text PDF Scopus (16) Google Scholar However, although the authors incorporated several factors in the decision survey that may be a priority for patients with stricture disease, there were multiple variables patients must frequently consider that were not included. Certain patients with limited life expectancy or access to care may opt for diversion with a perineal urethrostomy rather than surgical repair of their strictures, and the decision survey did not contain information related to this option, such as patient acceptance of seated voiding. Additionally, relevant factors such as patients' attitudes toward the possible need for intermittent catheterization following intervention, the effect of intervention on sexual function, and the need for referral to a tertiary center if complex urethroplasty is indicated were also not addressed. Regarding access to a provider with adequate expertise, a nationwide survey of practicing members of the American Urological Association in 2007 conducted by Bullock and Brandes found the majority of urologists surveyed (57.8%) did not perform urethroplasty surgery.