Although presented in 2002 at international meetings on continence care by clinical thought-leaders in the UK, a survey of 100 female patients in an urogynecologic clinic of a major, referral medical center went largely unnoticed in the U.S. Perhaps this is because of the heavy orientation of the American healthcare delivery system to the use of prescription drugs for managing symptoms and the disproportionate numbers of medical and surgical specialists over primary care providers.
The study revealed some highly relevant findings about consumer preferences with respect to treatment options for bladder control problems. While there may be some fundamental differences between Americans and the British, the fact remains that both populaces are relatively well educated, wealthy by global standards, enjoy a high standard, quality of life, and have access to advanced technology and all therapies of modern medicine. Therefore, it is reasonable to generalize and apply findings from this particular study among U.K. consumers to U.S. residents.
All female survey respondents complained of troublesome, lower urinary tract symptoms and had been referred for further investigation by their doctors. Their mean age was 48 years, ranging from 20 - 73. The mean duration of symptoms was six years, ranging from six months to 40 years. Among the respondents were those with various diagnostic categories, including stress urinary incontinence (leakage upon the pressure of coughing, sneezing, or laughter), overactive bladder, or OAB (urgency and incontinence and urge incontinence from OAB), and other voiding difficulties and sensory urgency. The research was conducted at Kings College Hospital in London.
What was found should be noted by all of us Americans for reflection: The majority of women possess realistic expectations regarding outcomes and are able to tolerate the inconvenience of minor lower urinary tract symptoms.
While most (60%) women are willing to consider a course (6 months) of pelvic floor exercises, most (69%) are not willing to take drugs for life for a bladder control condition such as OAB, nor willing (57%) to undergo a major operation (such as for stress urinary incontinence) with only an 85% likelihood of cure.
As for urinary retention and incomplete emptying of the bladder, four out of five (79%) are not willing to undertake long term catheterization as their only outcome. What is perhaps most interesting is the fact that the concept of cure was not influenced by symptom severity.
All of this speaks to the importance of patients speaking up when in dialogue with their doctors and nurses...........and, more importantly, of patients being fully informed, in understandable language, before consenting to any procedure, an operation, or even a medication. Our expectations are an integral part of what outcomes represent as well as how they are valued.
Published On: April 16, 2009