BERKELEY, CA (UroToday.com) - Lower urinary tract symptoms (LUTS) are associated with a significant negative impact on quality of life in both men and women. It is surprising to learn that while common in the population, urinary symptoms are not well characterized in regards to pathophysiology and severity. For example, many patients report post-void dribbling. However, this often represents a spectrum of symptoms from mild dampness to total incontinence after volitional voiding. In addition, the amount of bother or disturbance that a patient experiences related to these symptoms can also be variable; it is not uncommon for patients with identical urinary symptoms to report polar opposite degrees of bother. These differences in our understanding and descriptions often make the treatment of LUTS a challenge and source of frustration for the clinician and patient.
Victorson and colleagues recently examined differences between clinician and patient perception of urinary symptoms in men with prostate cancer. To this end, the authors asked experts in the field to classify urinary symptoms in men treated for prostate cancer into a conceptual structure and then empirically tested these findings using actual patient data. The results suggested that clinicians who treat prostate cancer tend to categorize urinary symptoms into at least 3 separate groups: leaking/incontinence, storage (irritative), and voiding (obstructive) symptoms. This categorization was generally consistent with patient responses. However, patients often did not perceive subtle distinctions in urinary symptoms, much less experience symptoms according to their clinicians’ rigid categories. The results of the study highlighted inconsistencies between the clinician and patient experience in the perception of urinary symptoms. It is likely that these differences may provide a common obstacle to the successful diagnosis and treatment of LUTS. Additional research is therefore required to improve our evaluation and measurement of urinary function.
The NIH-funded symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is an ongoing, multi-institutional, interdisciplinary team of researchers assembled to identify a significantly improved understanding and phenotyping effort of LUTS in both men and women. As a co-principle investigator of the LURN, we are striving to develop and expand upon existing urinary symptom based measurement tools to improve our understanding of LUTS initiation, progression and response to treatment in both men and women. Towards this end, an intensive effort to provide deep phenotyping of patients with LUTS will be performed. The results of these studies will help clarify the details and clinical characteristics surrounding current ambiguities surrounding many aspects of LUTS (e.g. post-void dribbling and bother). Finally, the goals of the LURN also include efforts towards the identification of novel biomarkers that can provide an objective way to better characterize and predict outcomes of LUTS. Detailed characterization of LUTS and its associated bother in men and women will help aid in the prediction of LUTS initiation, symptom flares, progression, and ultimately be used to create more personalized treatments.
Written by:
Brian T. Helfand, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Clinical Instructor NorthShore University HealthSystem, Evanston, IL
Assistant Research Professor, University of Chicago, Pritzker School of Medicine, Chicago, IL
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