QOL audits of TVT surgery applied to small patient numbers are a worthwhile addition to clinical practice

Abstract

This paper considers whether a validated quality of life (QoL) questionnaire would be a useful clinical audit tool for practitioners or units who operate for stress urinary incontinence, have a relatively small case-load and who may be interested in using these data for credentialing or reaccreditation. We prospectively evaluated changes in QoL domains using the King’s Health Questionnaire (KHQ) in a series of 14 women undergoing a TVT procedure. All women had urodynamically proven stress incontinence and completed the KHQ preoperatively and again between 12-61 (mean 32.8) months after surgery. The women were also asked to complete non-validated analog scale responses to two questions regarding satisfaction with the procedure and the extent of residual incontinence and to indicate whether they would recommend their procedure to a friend. Five of the nine KHQ domains showed clinically and statistically significant improvements in QoL and three domains showed clinically significant improvements which did not reach statistical significance. Six (43%) women were completely dry following their procedure and these were the only women who were completely satisfied. Nine women would definitely recommend the procedure to a friend. Prospective collection of KHQ data provides an estimate of the degree of improvement resulting from treatment and provides a basis for benchmarking of the performance of an individual or group. However, current QoL questionnaires are deficient when it comes to the evaluation of common complications of surgery such as urinary retention.