Variation in surgical treatment advice for women with stress urinary incontinence: a study using clinical case vignettes

Jil Billy Mamza,Dina El-Hamamsy,Philip Toozs-Hobson,Jan Van Der Meulen,Jonathan Duckett,Douglas Tincello,Tahir Mahmood,Ash Monga,Rebecca Geary,Andrew Wilson,Ipek Gurol

doi:10.1007/s00192-020-04295-4

Abstract

IntroductionThe aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics.MethodsTwo hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 ‘certainly not’ to 5 ‘certainly yes’. Mean scores were used to calculate the relative impact (‘weight’) of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way.ResultsThe gynaecologists’ overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0.ConclusionsSurgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery.

Highlights

The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics
The nature of the urinary incontinence had the greatest impact with a mean difference in the recommendation score for women with SUI and mixed urinary incontinence (MUI) of 0.8, which corresponds to a weight of 23%, closely followed by the impact of a woman’s previous history of SUI surgery and—albeit it to a lesser extent—the frequency of urinary leakage, body mass index (BMI) status and bother
The results of the mixed-effects analysis of variance indicated that all clinical characteristics captured in the case vignettes significantly influenced the recommendation score (p always < 0.001)

Summary

Introduction

The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way. Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. The decision to recommend surgery is complex and many factors need to be considered, including the patient's past management, comorbidities and the impact that the SUI has on quality of life. Recent UK guidelines emphasize that treatment decisions need to focus on providing a woman with the best outcomes from her own individual perspectives [4].

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