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New insights into overactive bladder urinary symptoms

Recent findings suggest that two manifestations of overactive bladder (OAB) may reflect a spectrum of symptom severity rather than two distinct subtypes. People with OAB may experience a variety of symptoms including increased urge to urinate (urinary urgency or UU), frequent urination, urine leakage (urgency urinary incontinence or UUI), and nocturia (nighttime frequent urination). Some hypothesize that UU and UUI represent different degrees of OAB symptoms (i.e., they are the same condition), while others hypothesize that they are two separate subtypes of OAB. Though OAB is a relatively common condition, there is limited understanding of the characteristics that distinguish people with UU from those with UUI, making the clinical management of these burdensome and painful conditions challenging. Increased knowledge about these conditions could help identify if some people respond better to certain treatments, enabling a more personalized and targeted approach to treatment.

In this observational study, people with lower urinary tract symptoms who were enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network study were characterized as experiencing either UU-only or UUI based on their answers to a questionnaire about their urinary symptoms. Of the 683 participants who reported urinary urgency at their initial visit, one-third were characterized with UU alone and two-thirds were characterized with UUI. At their initial appointment and at 3- and 12-month follow-ups, participants also answered questions to assess their urological pain, other urological symptoms, and quality of life. Individuals experiencing UU-only reported fewer symptoms like severe urgency and urinary frequency; lower levels of anxiety, depression, and stress; and better sleep and higher physical activity than those with UUI. Additionally, individuals with UUI reported a lower quality of life than those with UU alone. Interestingly, the researchers did not observe differences in urological pain between people with UU-only and people with UUI. The study investigators also observed that some people transitioned between UU-only and UUI after 12 months, whereas some improved to the point of having no urgency at all. These results suggested that UUI may be a more severe form of UU, rather than two different subtypes of OAB.

While this study provides new information about the symptoms of UU and UUI, further research is needed to definitively characterize the relationship between these conditions. A limitation of this study is that participants were followed for only 12 months. Longer observations of people with UU and UUI will provide better insight into their long-term impact on health and well-being. Further, since the population included was predominantly white, observations of more diverse groups will help determine whether these findings apply to all people living with OAB.

Lai HH, Wiseman JB, Helmuth ME,…Kenton K; for the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). Phenotyping of urinary urgency patients without urgency incontinence, and their comparison to urgency incontinence patients: findings from the LURN study. J Urol 209: 233-242, 2023.

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