Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Sep 12, 2020; 9(1): 9-15
Published online Sep 12, 2020. doi: 10.5410/wjcu.v9.i1.9
Evaluation of patient reported outcome measures post urethroplasty: Piloting a “Trifecta” approach
Michelle Ong, Catriona Duncan, Matthew McGrail, Devang J Desai
Michelle Ong, Catriona Duncan, Devang J Desai, Department of Urology, Toowoomba Hospital, Toowoomba 4350, Queensland, Australia
Matthew McGrail, Department of Head Regional Training Hub Research, University of Queensland Rural Clinical School, Rockhampton 4700, Queensland, Australia
Devang J Desai, University of Queensland Rural Clinical School, Toowoomba 4350, Queensland, Australia
Author contributions: Ong M and Duncan C were involved in study design, data collection, and manuscript writing; McGrail M was involved in statistical analysis of the data and collation of tables and result graphs; Desai D was involved through the supervision of the study and revision of the subsequent drafts of the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The collection of this data was approved by the Human Research Ethics Committee of Darling Downs Health Service.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We can declare that there are no conflict of interests
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michelle Ong, MBBS, Doctor, Department of Urology, Toowoomba Hospital, 154 Pechey Street, Toowoomba 4350, Queensland, Australia.
Received: March 22, 2020
Peer-review started: March 22, 2020
First decision: April 18, 2020
Revised: May 27, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 12, 2020

Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease. Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years. Patient reported outcome measure (PROM) questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.


To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.


Our database of urethroplasty patients was searched to identify patients who had completed the original PROM. This is routinely requested to be completed at the 3-, 6- and 12-mo mark. All patients are asked to complete the questionnaire and to bring it back to their next appointment. Our original PROM consists of the international prostate symptom score, the sexual health index measure and the Global Response Assessment. An abridged version of the questionnaire was derived focusing on urinary flow, sexual function and overall quality of life and consisted of three questions.


Sixty-six patients were included in our study. Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%. Compliance rates improved to 91% with the introduction of the modified PROM. No correlation between non-compliance and patient factors were found. There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.


We recommend the use of PROMs pre- and post-operatively to accurately determine the level of patient satisfaction. We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires. We propose a simplistic version aimed at the “Trifecta” of urethroplasty comprising of three questions focusing each on urinary flow, sexual function and quality of life. Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.

Keywords: Urethroplasty, Patient reported outcome measures, Satisfaction, Quality of life

Core Tip: This study demonstrates the use of a modified abridged patient reported outcome measure in patients undergoing buccal mucosal graft urethroplasty for urethral strictures. A significant improvement in compliance rate was observed indicating that this modified version may be a useful screening tool to accurately evaluate patient satisfaction post-operatively.