Overactive bladder phenotypes: development and preliminary data.

INTRODUCTION: The purpose of this study is to develop overactive bladder (OAB) phenotypes that can be used to develop diagnostic and treatment pathways and offer clues to the underlying etiologies of patients with OAB. MATERIALS AND METHODS: This is a retrospective, multicenter study of patients with lower urinary tract symptoms (LUTS). Evaluation included a 24-hour bladder diary (24HBD), the lower urinary tract symptoms score (LUTSS) questionnaire, uroflowmetry (Q), and post-void residual urine (PVR) measurement. Patients completed the 24HBD and LUTSS on a smartphone application or paper. Those with an OAB symptom sub-score (OABSS) ≥ 8 were included. An expert panel developed a phenotype classification system based on variables considered to be important for treatment. RESULTS: The following variables were selected for inclusion in the phenotype modeling: 24-hour voided volume (24HV), maximum voided volume (MVV), Qmax and PVR. Subjects were divided into three phenotypes based on the 24HV: polyuria (24HV > 2.5 L), normal (24 HV 1-2.5 L), and oliguria (24HV < 1 L). Each phenotype was subdivided based on MVV, Qmax & PVR, resulting in 18 sub-types. Five hundred thirty-three patients, 348 men and 185 women, completed the LUTSS and 24HBD. OAB was present in 399 (75%) - 261 men and 138 women. The prevalence of the primary phenotypes was polyuria (25%), normal (63%), and oliguria (11%). CONCLUSIONS: Classification of OAB variants into phenotypes based on 24HV, MVV, Qmax, and PVR provides the substrate for further research into the diagnosis, etiology, treatment outcomes and development of granular diagnostic and treatment algorithms.

Pubovaginal fascial sling for the treatment of all types of stress urinary incontinence: surgical technique and long-term outcome.

This article provides an update on the surgical technique and long-term outcome of the full-length autologous rectus fascial sling in the treatment of women with sphincteric incontinence. The autologous fascial puovaginal sling remains the gold standard against which other surgeries for treating sphincteric incontinence should be compared. The authors have demonstrated that this procedure can be performed in a reproducible fashion with minimal morbidity.

The urgency perception score: validation and test-retest.

PURPOSE: We validate a grading system for urinary urgency. MATERIALS AND METHODS: A total of 225 subjects participated in a validation study of a fixed format question that examined the reasons why an individual usually voids. The response comprised 5 graded categories. The written questionnaire was completed by the subject twice in 3 to 14 days, during which there was no change in symptoms. Subjects included asymptomatic normal volunteers and consecutive patients with lower urinary tract symptoms without urinary urgency and those with overactive bladder with or without other lower urinary tract symptoms. Content validity was established by an expert panel. Discriminant validity was assessed by examining the frequency of responses in the various categories across the 3 groups (chi-square test) and by comparing average scores in each of the 3 groups using 1-way ANOVA, followed by LSD post hoc tests. Test-retest reliability was assessed using the intraclass correlation coefficient and kappa coefficient. RESULTS: A total of 83 normal subjects, 62 patients with lower urinary tract symptoms and 80 patients with overactive bladder were included in the study. Median age was 71 years (range 21 to 97). For test-retest reliability the intraclass correlation coefficient (0.86) and kappa coefficient (0.68) indicated a good level of agreement (p <0.001). The overactive bladder group achieved a significantly higher score than the normal and lower urinary tract symptoms groups (mean +/- SD 2.5 +/- 0.99 vs 1.6 +/- 0.93 and 1.8 +/- 0.93, respectively, each p <0.001). CONCLUSIONS: The urgency perception score appears to be a valid and reliable means of grading urinary urgency. We believe that this method of grading urgency will prove to be more clinically useful than the simple yes/no characterization of urgency as a sudden compelling desire to void and it will be a useful item for questionnaires and diary keeping.