Correlation between symptom severity and bother in patients with lower urinary tract symptoms
Sources of Funding: Institute for Bladder and Prostate Research
Introduction
In the absence of bother, most treatment algorithms for lower urinary tract symptoms (LUTS) recommend reassurance and follow-up. The assumptions behind this recommendation are that 1) if the symptoms are not bothersome, the underlying condition is not serious enough to warrant further investigation, and 2) the worse the symptoms, the greater a patient will be bothered by those symptoms. The aim of this study is to evaluate these hypotheses.
Methods
This is an IRB approved retrospective multicenter study of consecutive men and women referred for LUTS who completed the LUTS symptom score (LUTSS) and/or AUA symptom score (AUASS) questionnaires. For those with more than one entry, the earliest score was used. Contemporaneous uroflow (Q), post-void residual (PVR), Patient Global Impression of Improvement (PGII), and clinical diagnosis were gathered when available. When more than one Q or PVR was available, the best one - greatest Q and lowest PVR - was used. Voided volumes <150 mL were excluded. Spearman correlations were calculated on the LUTSS bother score.
Results
1179 patients completed the LUTSS; correlations are seen in table 1. The overall correlation between total LUTSS and bother was moderate (plot 1). It was considerably lower among those who rated their improvement &[Prime]worse&[Prime] than &[Prime]about the same&[Prime] (r=0.24 vs 0.67). Among specific symptom subscores, the correlation between the relevant subscore and bother was fairly low (r=0.34-0.61). No correlation was found between Q or PVR versus bother or versus total LUTSS.
Conclusions
The correlation between patient bother, symptom severity and the severity of the underlying LUT condition is inexact. Additionally, there is no correlation between Q, PVR and symptom severity. Some patients with little bother and few symptoms have serious underlying conditions; others are bothered severely by what appear to be minor symptoms.
Funding
Institute for Bladder and Prostate Research
Lucas J Policastro
Zahava M Hirsch
Amy L O'Boyle
David Chaikin