Page 157 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

needs to be stimulated in order to increase the amount of high quality data towards such prediction model in functional urology.
Improvement of patient reported outcome measurements in functional urology
Physicians are trained proactively in including patients perspectives and to perform shared-decision making in order to maintain or improve quality of life (QoL) whilst improving survival. This has encouraged the development of PROMS. Important steps in implementation of questionnaires in health care are their translation and validation in the language and population in which they are used. In chapter 6, such translation and validation was executed, to make the “OAB-q SF” questionnaire usable in the Nether- lands. For different diseases in functional urology, different PROMS have been translated and validated so far.39-42 Health care organizations, such as the International Consortium for Health Outcome Measurements (ICHOM) have created ‘core-sets’ of questionnaires to use within a specific subspecialty or disease category and suggest worldwide consensus and use of these sets.43 The use of these PROMS-sets has to be encouraged as a means to gather more data, which in turn would facilitate developing a good prediction model. This ICHOM initiative creates the possibility to compare results of therapy for different types of patients. The OAB-q SF questionnaire, is to be used in the work-up for patients with overactive bladder.43 More knowledge on predicted outcomes might not only improve the success rates of conservative treatments but also achieve better patient selection for successful invasive treatments.
Improvement of patient selection for invasive treatments in functional urology In the study presented in chapter 7, we investigated the outcomes of the construction
of a continent catheterizable urinary channel in patients with bladder dysfunctions. In this invasive surgical procedure a urinary stoma is constructed on the anterior abdomi- nal wall using a part of the bowel, and by catheterization of this stoma, the bladder can be emptied. The decision to undergo such invasive treatment with major impact on the patient’s body image for a non-lethal disease is complex as the aim of the treatment is improvement of the QoL. The possible risks and benefits should therefore be weighted carefully.44,45 A challenge in the decision making, is the lack of predictive factors for the risk of complications, and in case of complications a possible decrease in the QoL. There- for the identification of these risk factors is important and could improve the patient selection for this treatment.46,47 The study quality of chapter 7 was limited, however, by the retrospective design. Since improvement in QoL is the aim of this therapy, this subjective outcome parameter should be reported pre- and postoperatively. Research in this patient category is hampered, by the limited number of patients, the hetero- geneous disease presentation, and the differences between the various interventions
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General discussion and future perspectives
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