An Evaluation of the Readability and Content-Quality of Pelvic Organ Prolapse YouTube Transcripts.

OBJECTIVE: To evaluate the readability, quality, and accuracy of pelvic organ prolapse (POP) YouTube transcripts. METHODS: We analyzed the readability of written transcripts for the first 100 YouTube videos about "Pelvic Organ Prolapse." Transcripts were excluded if they lacked narration in English or contained both no text and no audio. Readability was evaluated using an online software (www.readabilityformulas.com) to determine reading grade levels. The quality of videos was scored using the DISCERN quality criteria and the Patient Education Materials Assessment Tool. Accuracy was assessed by comparing content to accepted POP treatment guidelines. RESULTS: The median grade level of all 100 videos was 12.6. High quality transcripts or transcripts that discuss the benefits, risk, alternative treatments, and quality of life had a median readability score of 12.5. Transcripts with low misinformation (85%) had a higher median readability index (12.6), than transcripts containing high misinformation (12.2). More than 20% of transcripts discussed shared decision-making. The median readability index for videos with a high Patient Education Materials Assessment Tool score (>75%) for understandability and actionability were both 12.6. CONCLUSION: Transcripts of POP YouTube videos are written at difficult levels with many transcripts exceeding the reading capabilities of the American population. The majority of good transcripts or transcripts with high quality content, low misinformation, shared decision-making, no commercial bias, and understandable and actionable content were written at a high school level or above. Efforts should be made to avoid complex terms when creating patient focused content and helping patients navigate to content of appropriate literacy online.

Domain Comparison Between 6 Validated Questionnaires Administered to Women With Urinary Incontinence.

OBJECTIVES: To compare patients' questionnaire-reported urinary incontinence (UI) symptoms to determine which have the best concordance. METHODS: Women with self-reported mixed UI were asked to report quality of life (QoL) due to urinary problems on a visual analog scale and complete 6 standardized validated questionnaires with questions on mixed UI (Medical Epidemiological and Social Aspects of Aging questionnaire, the Urogenital Distress Inventory short form [UDI-6], the Incontinence impact questionnaire short form [IIQ-7], the International Consultation on Incontinence Questionnaire Urinary Incontinence short form [ICIQ-SF], the King's Health Questionnaire [KHQ], and Patient Global Impression of Severity Scale [PGI-S]). Specific questions related to stress urinary incontinence (SUI), urgency urinary incontinence (UUI), UI severity, and QoL were compared within surveys from each patient with a Pearson correlation coefficient. RESULTS: Twenty consecutive women participated in the study with a mean age of 64 ± 13 years and mean time to complete all surveys of 11.2 ± 5.4 minutes. In SUI and UUI subdomains, KHQ, UDI-6, and Medical Epidemiological and Social Aspects of Aging questionnaire were well correlated, however, specific ICIQ questions related to SUI and UUI were less often well correlated. For severity subdomains the UDI-6 score was poorly correlated with the KHQ, PGI-S, and ICIQ scores (all P> .1). KHQ correlated well with the PGI-S (0.64, P= .003) and ICIQ score (0.58, P= .008). PGI-S and ICIQ severity scores were also well correlated (0.56, P= .012). QoL on a VAS (range: 1-10) was significantly well correlated with both KHQ (0.75, P<.001) and the IIQ-7 (0.64, P= .003). KHQ and IIQ-7 were also well correlated (0.64, P= .003). CONCLUSION: In this pilot study, validated questionnaires with questions regarding UI are mostly well correlated in women for subdomains of SUI, UUI, QoL, and severity. For UI symptoms and UI symptom severity the ICIQ and UDI-6, respectively, are poorly correlated with other survey results and may be less indicative of patient's complaints.

Prospective Evaluation of Urodynamic Utility in a Subspecialty Tertiary Practice.

OBJECTIVE: To prospectively evaluated the utility of urodynamic evaluations (UDS) ordered in a tertiary referral center as part of a quality improvement project. METHODS: Patients with UDS ordered by 3 subspecialty physicians were included. Physicians were surveyed when ordering UDS and at the post-UDS clinic visit to assess indications for UDS, pre- and post-UDS diagnosis, treatment plan, confidence level, and perceived helpfulness of UDS. UDS trained nurses conducting studies were surveyed on patient reported reproducibility of their symptoms and perceived difficulty of UDS. RESULTS: From April 2017 to October 2017, 127 UDS were included of which 102 met study criteria. UDS were done for neurogenic (23%) and non-neurogenic lower urinary tract symptoms (76%). The majority were conducted for incontinence evaluation (79%), or after prior lower urinary tract surgery (33%). UDS nurses reported 90% of UDS fully or partially reproduced patient symptoms. Nurses found 18% of UDS difficult due to catheter malfunctions, physical limitations, and communication abilities. Post-UDS, providers found 97% of UDS interpretable. UDS resulted in a change in treatment plan in 78% of patients. On a Likert scale, mean pre-UDS confidence level was 2.9 ± 0.8 (range 0-5). This increased to 4.1 ± 0.6 post-UDS with 76% of evaluations having a change of at least 1 point. CONCLUSION: UDS in a tertiary referral center result in change in patient treatment plans over three-fourths of the time with high rates of interpretability.

Patient Characteristics and Perioperative Outcomes of Female Urethral Diverticulectomy: Analysis of a Multi-Institutional Prospective Database.

OBJECTIVE: To assess the patient and perioperative characteristics of urethral diverticulectomy using a large multi-institutional prospectively collected database. MATERIALS AND METHODS: Female patients were identified using the American College of Surgeons National Surgical Quality Improvement Program participant user files (2007-2012) and current procedural terminology codes for urethral diverticulectomy (53,230). Preoperative variables and 30-day complications were examined. RESULTS: Urethral diverticulectomies were performed on 122 females during the study period. The cohort was relatively healthy; 80% of patients had an American Society of Anesthesiologists score of 1 or 2. The majority of procedures were performed in an outpatient setting (82%). The median procedure length was 77.5 minutes (interquartile range: 50.5-112.5), and the median length of stay was 0 days (interquartile range: 0-1). The overall 30-day complication rate was 3.3% (n = 4): 3 patients developed urinary tract infections (UTIs) and 1 patient developed both a UTI and a superficial wound infection. CONCLUSION: To our knowledge, our study represents the largest multi-institutional cohort of patients having undergone urethral diverticulectomy. The patients requiring this intervention were relatively healthy, and the procedure itself was short, allowing most patients to be discharged within 24 hours. The 30-day complication rate was very low, with UTI being the most common complication. Thus, patients can continue to be confidently counseled that urethral diverticulectomy is a safe procedure with very few perioperative complications.