Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder?

Area of Science:

• Urology
• Neurosurgery
• Patient-centered outcomes research

Background:

• Traditional urological procedure success relies on objective endpoints, potentially overlooking patient satisfaction.
• Patient-centered metrics like satisfaction and decisional regret are understudied in urology.
• Sacral neuromodulation (SNM) is a treatment for refractory overactive bladder (OAB).

Purpose of the Study:

• To investigate long-term patient satisfaction and decisional regret after sacral neuromodulation (SNM) for refractory overactive bladder (OAB).
• To evaluate the impact of patient-centered outcomes in assessing the success of SNM.
• To provide data for shared decision-making in OAB treatment.

Main Methods:

• Retrospective review of 191 patients who underwent SNM for refractory OAB (2015-2022).
• Patient satisfaction and decisional regret assessed using the modified Satisfaction with Decision Scale-Decision Regret Scale (SDS-DRS).
• Statistical analyses included descriptive statistics, Wilcoxan rank sum, and median regression.

Main Results:

• A 70% response rate (89/128) was achieved from reachable patients.
• Median satisfaction score was 4.0 (high satisfaction), and median decisional regret score was 2.0 (low regret) at a mean follow-up of 37.3 months.
• Postoperative complications (n=10) were significantly associated with lower satisfaction and higher regret, persisting after adjustments.

Conclusions:

• Patients generally report high satisfaction and low decisional regret following SNM for refractory OAB, even at long-term follow-up.
• Postoperative complications negatively impact patient-reported outcomes.
• Incorporating patient-centric outcomes is crucial for evaluating surgical success and guiding shared decision-making for OAB management.