Design and Validation of the Marmara Post-prostatectomy Incontinence Symptom Score

Design and Validation of the Marmara Post-prostatectomy Incontinence Symptom Score Marmara Post-prostatektomi İdrar Kaçırma Semptom Skoru Oluşturulması ve Validasyonu Doi: 10.4274/jus.1097 Journal of Urological Surgery, 2017;4:1-7 Murat Akgül1, Muhammed Sulukaya2, Ahmet Şahan3, Nural Bekiroğlu4, İlker Tinay2, Levent Türkeri2, Tufan Tarcan2 1Tuzla State Hospital, Clinic of Urology, İstanbul, Turkiye 2Marmara University Faculty of Medicine, Department of Urology, İstanbul, Turkiye 3Ümraniye Training and Research Hospital, Clinic of Urology, İstanbul, Turkiye 4Marmara University Faculty of Medicine, Department of Biostatistics, İstanbul, Turkiye Abstract What’s known on the subject? and What does the study add? Incontinence developing after post-prostatectomy is a very disturbing problem. There are many questionnaires for evaluating incontinence in the field of urology. There is however no dedicated form which evaluates incontinence that develops particularly after prostatectomy. The present study explores a valid and reliable questionnaire in analysis of post-prostatectomy incontinence. Objective: This study aims to validate the “Marmara post-prostatectomy incontinence symptom score (M-PPISS)” designed for the assessment of post-prostatectomy incontinence (PPI). Materials and Methods: The questionnaire consists of 3 sections including 8 questions (4 questions examining the type and degree of PPI, 3 questions examining the effect of PPI on quality of life (QoL) and 1 question examining bladder emptying) and an analogue scale to assess the impact of PPI on the QoL. The questionnaire was completed by 106 patients, who underwent radical prostatectomy (RP) in our clinic between 2007 and 2015, at the end of the first week, first month and at 3-month intervals up to one year after RP. Results: The mean score of 106 patients at the end of the first week after the operation was 6.57 (minimum: 0, maximum: 24). The internal consistency coefficient measured for our questionnaire was found to be higher (Cronbach’s alpha: 0.887). When an item was deleted, Cronbach’s alpha was not lower than 0.85 for any value. According to the 27% rule, p value was calculated as 0.0001. In the numerical evaluation of total score and the analogue scale considering QoL (satisfaction and dissatisfaction); patients with a total score of 0-4 were accepted as “satisfied with QoL”, while patients with a total score of ≥5 were included in the dissatisfied group (cut-off value: 5). Conclusion: The M-PPISS was found to be a reliable and valid instrument in the evaluation of urinary incontinence after RP. Keywords: Prostatectomy, incontinence, questionnaire, validation Amaç: Çalışmamızda prostatektomi sonrası idrar kaçırma (PSİK) değerlendirilmesi için oluşturduğumuz “Marmara post-prostatektomi idrar kaçırma semptom skoru (M-PPİKSS)” validasyonu amaçlandı. Gereç ve Yöntem: Sorgulama formu 3 bölümden oluşmakta ve idrar kaçırma şeklini ve miktarını sorgulayan 4 soru, idrar kaçırmanın yaşam kalitesi üzerine olan etkilerini sorgulayan 3 soru ve mesane boşaltımını sorgulayan 1 soru olmak üzere toplam 8 soru bulunmaktadır. Bu sorgulama formu kliniğimizde 2007-2015 yılları arasında radikal prostatektomi (RP) operasyonu uygulanan hastalardan 106 tanesine operasyon sonrası 1. hafta, 1. ay ve 3 aylık kontrolleri sırasında dolduruldu ve sonuçları sorgulama formunun validasyonu açısından değerlendirildi. Bulgular: Ameliyat sonrası 1. haftada toplam 106 hastanın ortalama skorları 6,57 (minimum: 0, maksimum: 24) olarak bulundu. Sorgulama formu için hesaplanan iç tutarlılık katsayısı yüksek tespit edildi (Cronbach’s alfa: 0,887). Öğe silindiğinde Cronbach’s alfanın hiçbir değer için 0,85’in altına düşmediği izlendi. %27 kuralına göre ise p değeri 0,0001 olarak hesaplandı. Toplam skor ile analog skala arasında yaşam kalitesi düşünülerek Introduction Incontinence, which develops after surgical interventions for prostatic diseases such as prostate cancer (PC) and benign prostatic hyperplasia, is a disturbing problem and affects a significant group of patients with varying intensity (1). Radical prostatectomy (RP) remains the most common treatment option for the treatment of localized PC (2). However, in spite of the advances in the techniques and technology, post-RP incontinence affects 4 to 50% of patients mildly and 0 to 15.4% of patients severely (3,4,5). Besides routine urological evaluation for post-RP incontinence, using a questionnaire can be helpful for the assessment of the nature and quantity of the incontinence and its effect on the quality of life (QoL). There are a number of questionnaires for evaluating incontinence in the field of urology. Those forms are important for the purpose of standardizing the information received from the patients and eliminating subjectivity and, such questionnaires are recommended to be used in daily practice (6). There are 4 questionnaires, which are validated, investigating incontinence and impotence after RP (7,8,9,10). However, the need for a brief and dedicated questionnaire still exists for the evaluation of incontinence developing particularly after RP. In this study, we aimed to introduce and validate the “Marmara post-prostatectomy incontinence symptom score (M-PPISS)” form for the evaluation of post-prostatectomy incontinence. Materials and Methods The M-PPISS questionnaire consists of 3 sections with a total of 8 questions (Annex 1). In the first section, there are 4 questions regarding the type and severity of incontinence where five different answers can be given from (0) never to permanently/ frequently (4). In the second section, there are 3 questions, questioning the effects of incontinence on the QoL, where four different answers can be given from (0) never to very much (3). And in the last section, there is 1 question questioning bladder emptying, where four different answers can be given from (0) (I urinate comfortably) to 3 (I cannot urinate at all). Total scores vary between 0 and 28. Furthermore, there is an analog scale which helps to evaluate the overall QoL related to micturition status at the end of the questionnaire. Such analog scale is in the range I am happy (0) - I feel miserable (6). For the validation of the questionnaire, a total of 106 patients, who underwent RP operation in our clinic between 2007 and 2015, completed the M-PPISS at the 1st week, 1st month and 3 months controls after the RP. Statistical Analysis Validity and reliability analyses were performed using SPSS 17.0 software. A p value of less than 0.05 was considered statistically significant. Results The average age of the 106 patients, who completed the M-PPISS questionnaire, was 63.9±6.4 years. The average M-PPISS scores of the patients are presented in Table 1, where continuous decreases were observed with longer follow-up periods (Table 1). After test-retest analysis carried out by means of comparing 1st week, 1st month and 3 monthly M-PPISS during follow-up, where significant differences were observed in the answers given by the patients to each question, in total score and in averages (p