Phenotyping of Urinary Urgency Patients Without Urgency Incontinence, and Their Comparison to Urgency Incontinence Patients: Findings From the LURN Study

Abstract

Purpose: We characterize patients with urinary urgency with vs without urgency urinary incontinence who presented to clinics actively seeking treatment for their symptoms.

Materials and methods: Participants who enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network were categorized into urinary urgency with vs without urgency urinary incontinence. Participants were followed for 1 year; their urinary symptoms, urological pain, psychosocial factors, bowel function, sleep disturbance, physical activity levels, physical function, and quality of life were compared. Mixed effects linear regression models were used to examine the relationships between urgency urinary incontinence and these factors.

Results: Among 683 participants with urinary urgency at baseline, two-thirds (n=453) also had urgency urinary incontinence; one-third (n=230) had urinary urgency-only without urgency urinary incontinence. No differences were detected in urological pain between urinary urgency-only and urgency urinary incontinence. Those with urgency urinary incontinence had more severe urgency and frequency symptoms, higher depression, anxiety, perceived stress scores, more severe bowel dysfunction and sleep disturbance, lower physical activity levels, lower physical function, and worse quality of life than those with urinary urgency-only. Among those with urinary urgency-only at baseline, 40% continued to have urinary urgency-only, 15% progressed to urgency urinary incontinence, and 45% had no urgency at 12 months. Fifty-eight percent with urgency urinary incontinence at baseline continued to report urgency urinary incontinence at 12 months, while 15% improved to urinary urgency-only, and 27% had no urgency.

Conclusions: Patients with urgency urinary incontinence have severe storage symptoms, more psychosocial symptoms, poorer physical functioning, and worse quality of life. Our data suggested urgency urinary incontinence may be a more severe manifestation of urinary urgency, rather than urinary urgency and urgency urinary incontinence being distinct entities.

Keywords: lower urinary tract symptoms; overactive; urgency; urgency urinary incontinence; urinary bladder.

Figure 1.. Bar charts of urgency status over time (by urgency status at baseline).

* Stacked bar chart of urgency status at 3-month and 12-month visits, paneled by baseline urgency status. Baseline urgency status is shown on the right y-axis, visit is shown on the left y-axis, and percent is shown on the x-axis. For each combination of baseline urgency status and visit, the proportion of participants who have no urgency (blue), UU-only without UUI (red), and with UUI (green) at the given visit is shown. [Footnote:] *Among the 1037 participants who provided responses to the baseline LUTS Tool item reporting on urinary urgency, 875 (84%) and 824 (79%) participants had LUTS Tool urgency and UUI severity responses at 3- and 12-month visits, respectively. The bar charts reported participants who provided responses at baseline, 3-, and 12-months to track their transition over time.

Figure 2.. Forest plot of mixed effect model results for urologic and non-urologic factors at baseline, 3-, and 12-months. Regression coefficients are displayed on the right.

Forest plot of mixed effect model coefficients for urologic and non-urologic factors at baseline, 3-month, and 12-month visits. For each urologic and non-urologic factor shown on the y-axis, the regression coefficient for the LUTS Tool UUI question (i.e., the estimated average change in the factor per unit change in the LUTS Tool UUI question, rescaled from 0–100) is shown on the x-axis for baseline (square), 3-month (circle), and 12-month (triangle) visits. The blue horizontal line straddling each estimate represents the 95% CI for that estimate, with any blue horizontal line crossing the vertical reference line at zero representing statistical significance at the 0.05 level. Coefficient estimates to the right of the reference line represent higher levels of the self-reported measure per unit increase in UUI severity, and estimates to the left represent lower levels per unit increase in UUI severity. If there was a statistically significant interaction with visit, the regression coefficient is shown for each visit; otherwise, the regression coefficient for any given visit is shown for each visit (i.e., the same coefficient for all visits). Unscaled regression coefficients are shown on the right, with an asterisk also indicating statistical significance at the 0.05 level. The interaction between visit and LUTS Tool UUI severity was statistically significant for LUTS Tool pain and voiding scales, UDI-6, GUPI urinary subscale, POPDI-6, and the GUPI QOL subscale, indicating that the estimated association between UUI severity and the outcome differed significantly during at least one pair of visits. For all other models, the interaction between visit and LUTS Tool UUI severity was not statistically significant. However, in each model, there was still a significant association between the measure and increases in UUI severity. For the GUPI, changes of 7.8, 3.7, and 5.5 points were seen in responders to pelvic floor physical therapy for the Pain, Urinary, and QOL subscales, respectively. For PROMIS T-scores, minimally important differences of 3 to 5 points have been established. For the UDI-6 and POPDI-6, 11 points has been proposed as a minimally important difference.^, There are no established minimally important differences for the LUTS Tool. [Footnote:] *Regression coefficient is statistically significant at the 0.05 level.