Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Departments of Surgery (Urology) and Anesthesiology, Washington University School of Medicine in St Louis, St. Louis, MO, USA.
BJU Int. 2019 Apr;123(4):682-693. doi: 10.1111/bju.14568. Epub 2018 Oct 24.
To address challenges in the diagnosis and classification of storage lower urinary tract symptoms (LUTS), we sought to define the fundamental features of overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), two conditions with considerable symptomatic overlap. Through retrospective comparison of self-reported symptoms in women with a range of clinical presentations and symptom severities, we have attempted to refine the diagnostic features of OAB and IC/BPS and to develop a novel clinical nomogram to improve patient screening and classification.
We performed a univariate analysis comparing responses to the female Genitourinary Pain Index (fGUPI), the OAB Questionnaire and O'Leary-Sant Indices (the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index) in an initial cohort of 50 patients with OAB, patients with IC/BPS and control subjects. Only eight questions differed significantly between the IC/BPS and OAB groups; we used five unique questions and three measuring bother to generate a novel composite scoring system and nomogram that included urgency incontinence, bladder pain and symptomatic bother domains to differentiate these populations, which was validated in a second cohort of 150 patients. The addition of a self-reported bother index resulted in the creation of a diagnostic algorithm to identify and classify LUTS clusters across the total population.
While all validated questionnaires could distinguish between controls and patients with storage LUTS, no combined symptom scores differed significantly between the IC/BPS and OAB groups. These results are reflective of the prevalence of significant bladder pain (35%) in patients with OAB and the presence of urge incontinence (25%) in patients with IC/BPS. Only the fGUPI pain domain scores differed between patients in the OAB and IC/BPS groups, but it was not accurate enough for diagnostic evaluation (68% accuracy). Our composite scores and nomogram gave a much-improved diagnostic accuracy (94%) and demonstrated utility as a screening tool to identify storage LUTS in patients presenting for unrelated complaints, e.g. microhaematuria.
There is significant overlap of urinary tract symptoms between OAB and IC/BPS. We present a novel algorithm that provides a binary output capable of guiding clinical diagnosis. Future studies aimed at assessing the diagnostic value of novel classification schemes that address symptoms rather than specific diagnoses may improve patient prognosis.
为了解决下尿路储存症状（LUTS）诊断和分类中的挑战，我们试图确定膀胱过度活动症（OAB）和间质性膀胱炎/膀胱疼痛综合征（IC/BPS）的基本特征，这两种疾病具有相当大的症状重叠。通过对具有不同临床表现和症状严重程度的女性患者的自报告症状进行回顾性比较，我们试图细化 OAB 和 IC/BPS 的诊断特征，并开发一种新的临床列线图以改善患者的筛查和分类。
我们对 50 例 OAB 患者、IC/BPS 患者和对照组患者的女性泌尿生殖疼痛指数（fGUPI）、OAB 问卷和 O'Leary-Sant 指数（IC 症状指数和 IC 问题指数）的反应进行了单变量分析。IC/BPS 和 OAB 组之间只有 8 个问题有显著差异；我们使用 5 个独特的问题和 3 个测量困扰来生成一个新的综合评分系统和列线图，该系统包括急迫性尿失禁、膀胱疼痛和症状困扰域，以区分这些人群，在第二组 150 例患者中进行了验证。添加自我报告的困扰指数可创建一个诊断算法，以识别和分类整个人群的 LUTS 集群。
虽然所有验证过的问卷都可以区分对照组和有储存 LUTS 的患者，但 IC/BPS 和 OAB 组之间的联合症状评分没有显著差异。这些结果反映了 OAB 患者中膀胱疼痛（35%）的高发率和 IC/BPS 患者中急迫性尿失禁（25%）的存在。只有 OAB 和 IC/BPS 组患者的 fGUPI 疼痛域评分不同，但对于诊断评估不够准确（68%的准确性）。我们的综合评分和列线图大大提高了诊断准确性（94%），并作为一种筛选工具，用于识别因无关主诉就诊的患者（如微量血尿）的储存 LUTS。
OAB 和 IC/BPS 之间存在明显的尿路症状重叠。我们提出了一种新的算法，可以提供二元输出，能够指导临床诊断。未来旨在评估解决症状而非特定诊断的新分类方案的诊断价值的研究可能会改善患者的预后。
