Introduction: Post-prostatectomy incontinence occurs in approximately 6% of men. The gold standard of treatment for post-prostatectomy incontinence defined in the 2018 AUA/SUFU guidelines is the placement of a male sling or artificial urinary sphincter. Patient counseling and education are essential for appropriate expectations and patient satisfaction. In this study we assessed the quality of information on YouTube regarding post-prostatectomy incontinence treatments.
Methods: The top 100 YouTube videos referencing “post-prostatectomy incontinence” and “male stress incontinence” were assessed using the validated DISCERN instrument, Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT A-V), and a misinformation Likert Scale. Videos with poor video/audio quality, duplicates, and non-English videos were excluded. Four independent raters were randomly assigned such that each video had 2 raters. Data was analyzed using multivariate linear regression, and inter-rater reliability was measured using Cohen’s kappa.
Results: Video characteristics are outlined in Table 1. The median DISCERN score was 2.5. The median PEMAT Actionability and Understandability scores were 64.6 and 79.9, respectively. The median misinformation Likert score was 1 (no misinformation) with 89% of them ranging from 1 to 2. Less than half of the videos discussed realistic treatment outcomes or the risks of treatment (39% and 24%, respectively). PEMAT Actionability score and whether risks were discussed significantly predicted average DISCERN score (p < 0.001). For inter-relater reliability, there were no significant disagreements between each rater based on Cohen’s kappa.
Conclusions: YouTube plays a large role in self-education for patients. Our study shows most videos on post-prostatectomy incontinence do not have significant misinformation and were published by medical professionals. However, the majority did not sufficiently discuss realistic outcomes and risks of treatment, which are hallmarks of informed decision making for patients. This provides an opportunity for the urologic community to create educational material including videos that emphasize appropriate expectations as are outlined in the 2018 AUA/SUFU guidelines for patients undergoing treatment for post-prostatectomy incontinence.