Study of self-reported symptom clusters may improve the diagnosis and treatment of women with lower urinary tract disorders

Currently, women with lower urinary tract symptoms (LUTS) are treated according to their most troubling symptom. This approach is not always completely successful, as it does not take into account that patients can have multiple symptoms that respond to different treatments.

A team led by Victor P. Andreev, PhD, of Arbor Research Collaborative for Health is proposing the development of new LUTS diagnostic classifications for women. They studied data from the six clinical centers of the Lower Urinary Tract Dysfunction Network (LURN), with a goal of improving treatment by better understanding a patient’s needs and symptoms.

They studied data from 545 women seeking care for LUTS. By analyzing patterns of multiple urinary issues rather than just the most problematic ones, they identified four symptom clusters that were different than those currently used, and may be more clinically relevant. None of the clusters could be characterized by a single symptom, but instead by a combination of symptoms with different levels of severity. All clusters, however, included at least one member from each currently used group (continent, stress incontinence, urgency incontinence, mixed incontinence, and other incontinence). The new groupings were:

1. continent, but had post-void dribbling.
2. reported urgency incontinence, urgency and frequency, and very minimal voiding symptoms or stress incontinence.
3. reported all types of incontinence, urgency, frequency, and very mild voiding symptoms (most common).
4. reported all LUTS at uniformly high levels.

This work is a promising beginning, as we don’t yet know the clinical significance of these clusters. Dr. Andreev added that “We believe that Lower Urinary Tract Dysfunction is a complex condition determined by multiple factors, including biochemical imbalances and problems with neural regulation. Therefore we are now working on the refinement of our clusters by integrating other types of data collected in LURN, including comorbidities, biomarkers, and even neuroimaging data.”

This study may lay the foundation for a better understanding of LUTS, unbiased diagnoses, and personalized treatment of patients. Future analyses may show whether these subtypes can be used to guide treatment. Study of subtypes of LUTS in men is also underway.