Symptoms of Lower Urinary Tract Dysfunction Research Network

Abstract

Purpose: To address gaps in understanding and treating lower urinary tract symptoms, the NIDDK created the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). The goals of LURN are to work collaboratively to 1) identify and explain the important subtypes of lower urinary tract symptoms; 2) improve the measurement of patient experiences of lower urinary tract symptoms; 3) disseminate novel findings to researchers, clinicians and patients; and 4) generate data, research tools and biological samples for future studies.

Materials and methods: As a first step in understanding subtypes of lower urinary tract symptoms, LURN will focus on disorders of urinary sensation (eg urgency) and their causes. These are being examined with respect to patient experience, organism or systemic factors, genitourinary organs and tissues, and cellular/molecular factors. This is being achieved via an observational cohort study that is currently enrolling patients with lower urinary tract symptoms (target number 1,000) and that will extensively characterize patients with lower urinary tract symptoms. Future studies embedded within the observational cohort study will focus on neuroimaging and sensory testing, biomarkers and organ based factors. To advance the science of measurement of lower urinary tract symptoms, LURN is also developing and evaluating a comprehensive set of self-report questions to provide more granular assessments of lower urinary tract symptoms.

Results: LURN has taken its first steps by developing a framework for studying lower urinary tract symptom subtypes.

Conclusions: In developing this framework, LURN is choosing an initial domain on which to focus (sensory experiences), and creating and executing protocols designed to improve measurement of self-reported symptoms and identify patient subtypes.

Keywords: government agencies; lower urinary tract symptoms; research.

Figure 1. Conceptual representation of LURN studies

Figure 1a. Conceptual framework within which all of the LURN research efforts can be understood. The structure of this framework is a “knowledge space” imagined here as a cube, representing all possible knowledge about LUTD—a cube that is now only partially and irregularly filled because the majority of research done heretofore has been done in relative isolation. The work of LURN is a systematic effort to “fill in” this knowledge space. Figure 1b. Components of LURN phenotyping studies. The LURN approach to phenotyping will be to start with a prospective observational cohort of subjects with LUTD. This cohort will also serve as the basis for further studies, which will allow more in-depth characterization of subsets of participants. These targeted studies will focus on sensory disorders of the urinary tract, and include neuroimaging and multimodal sensory testing, organ-based studies (i.e., testing of bladder and urethral function), and the evaluation of biological samples for biomarkers. Figure 1c. Interaction of LURN studies. LURN is purposely and prospectively examining multiple factors looking for associations, rather than trying to isolate specific factors-- an entirely unique approach to the study of LUTD. The arrows designate the possible associations and links between the substudies, and they are not limited to the combinations shown here.

Figure 1. Conceptual representation of LURN studies

Figure 1a. Conceptual framework within which all of the LURN research efforts can be understood. The structure of this framework is a “knowledge space” imagined here as a cube, representing all possible knowledge about LUTD—a cube that is now only partially and irregularly filled because the majority of research done heretofore has been done in relative isolation. The work of LURN is a systematic effort to “fill in” this knowledge space. Figure 1b. Components of LURN phenotyping studies. The LURN approach to phenotyping will be to start with a prospective observational cohort of subjects with LUTD. This cohort will also serve as the basis for further studies, which will allow more in-depth characterization of subsets of participants. These targeted studies will focus on sensory disorders of the urinary tract, and include neuroimaging and multimodal sensory testing, organ-based studies (i.e., testing of bladder and urethral function), and the evaluation of biological samples for biomarkers. Figure 1c. Interaction of LURN studies. LURN is purposely and prospectively examining multiple factors looking for associations, rather than trying to isolate specific factors-- an entirely unique approach to the study of LUTD. The arrows designate the possible associations and links between the substudies, and they are not limited to the combinations shown here.

Figure 1. Conceptual representation of LURN studies

Figure 1a. Conceptual framework within which all of the LURN research efforts can be understood. The structure of this framework is a “knowledge space” imagined here as a cube, representing all possible knowledge about LUTD—a cube that is now only partially and irregularly filled because the majority of research done heretofore has been done in relative isolation. The work of LURN is a systematic effort to “fill in” this knowledge space. Figure 1b. Components of LURN phenotyping studies. The LURN approach to phenotyping will be to start with a prospective observational cohort of subjects with LUTD. This cohort will also serve as the basis for further studies, which will allow more in-depth characterization of subsets of participants. These targeted studies will focus on sensory disorders of the urinary tract, and include neuroimaging and multimodal sensory testing, organ-based studies (i.e., testing of bladder and urethral function), and the evaluation of biological samples for biomarkers. Figure 1c. Interaction of LURN studies. LURN is purposely and prospectively examining multiple factors looking for associations, rather than trying to isolate specific factors-- an entirely unique approach to the study of LUTD. The arrows designate the possible associations and links between the substudies, and they are not limited to the combinations shown here.