Use of immediate intravesical chemotherapy by Urological Surgery Quality Collaborative practices is higher than reported elsewhere but still varies widely, even among ideal candidates. Efforts to optimize use will be aided by disseminating evidence supporting indications and benefits of intravesical chemotherapy, and by addressing local logistic factors that limit access to this evidence-based therapy.

Purpose: To improve the potential for finding clinically important subtypes of patients with lower urinary tract symptoms (LUTS), we describe the development of the Comprehensive Assessment of Self-reported Urinary Symptoms (CASUS) —and use it to present data on the experiences of LUTS in treatment-seeking women and men from a prospective observational cohort. Materials and Methods: An initial list of LUTS as confirmed in 22 qualitative interviews with providers and 88 qualitative interviews with care-seeking and non-care-seeking women and men with LUTS. Items from extant measures were adopted and revised and new items were developed, and all were evaluated for understanding in 64 cognitive interviews. Items were administered to a prospective cohort of female and male LUTS patients seeking care and analyses were conducted to describe item response distributions and correlations among item responses separately for women and men. Results: A total of 444 males and 372 females provided responses to CASUS. There were several sets of items that had different relationships for women compared to men. In particular, the associations between sensation-related items and incontinence-related items were generally positive among females, but were often negative among males. Conclusions: Using an intensive development process, the CASUS addresses a wide range of LUTS. It should help to identify clinically important subtypes of patients. Further, the collection of items can provide the foundation for shorter measures for use in the clinic and as trial endpoints.

Aims Bowel symptoms, pelvic organ prolapse, and sexual dysfunction are common, but their frequency among women with lower urinary tract symptoms (LUTS) has not been well described. Our aims were to describe pelvic floor symptoms among women with and without urinary incontinence (UI) and among subtypes of UI. Methods Women with LUTS seeking care at six U.S. tertiary care centers enrolled in prospective cohort study were studied. At baseline, participants completed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), and PROMIS GI Diarrhea, Constipation, and Fecal Incontinence Scales. Results Mean age among the 510 women was 56.4 ± 14.4 years. Women who reported UI (n=420) had more diarrhea and constipation symptoms (mean scores 49.5 vs 46.2 [p=0.01] and 51.9 vs 48.4 [p<0.01], respectively) at baseline. Among sexually active women, mean PISQ-IR subscale scores were lower among those with UI (condition specific: 89.8 vs 96.7, p<0.01; condition impact: 79.8 vs 92.5, p<0.01). Women with mixed urinary incontinence (MUI) (n=240) reported more prolapse symptoms, fecal incontinence, and worse sexual function compared to those with stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Conclusions Women presenting with LUTS with UI reported significantly worse constipation, diarrhea, fecal incontinence, and sexual function compared to women without UI. In women with UI, sexual function and pelvic organ prolapse (POP) symptoms were worse in those with MUI compared to SUI and UUI.

Purpose Despite management, some patients continue to have bothersome lower urinary tract symptoms (LUTS). We examined characteristics associated with LUTS bother in a prospective cohort. Materials and Methods Data were obtained from care-seeking patients with LUTS at six US tertiary-care centers in a one-year prospective, observational cohort study. Participants answered the American Urological Association Symptom Index global urinary bother question at study entry and 12 months later. Multiple linear and logistic regressions were used to identify factors associated with 12-month urinary bother. Results Of 756 participants, 121 (16%) had worsened LUTS bother over the study period. Baseline factors associated with more severe bother at 12 months among men included non-white race, hypertension, worse urinary frequency and incontinence, and higher levels of stress (all p<0.05). Among women, more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months. Adjusted for other variables, worsened LUTS were more likely among men who were non-white (OR [95% CI]=1.79 [0.95–3.39]) or diabetic (OR=1.68 [0.86–3.26]) and among women with diabetes (OR=1.78 [0.86–3.65]), prior LUTS treatment (OR= 2.59 [1.24–5.40]), or higher levels of depression (OR=1.30 [1.11–1.53]). Conclusion Urinary symptom severity at baseline, race, depression, and psychological stress were associated with LUTS bother in a prospective cohort of men and women treated at tertiary-care facilities. These findings may inform the clinical care of patients with bothersome LUTS and direct providers to better prognosticate challenging LUTS cases.

Huntington’s disease (HD) can be associated with pathologic involvement beyond the striatum including the autonomic nervous system. Bladder, bowel, and sexual dysfunction have been reported independently in HD, but little is known about their concomitant occurrence. To document this concomitant phenomena, forty-eight subjects (54% male, ages 28–74 years, CAG repeat 38–61) with manifest/symptomatic HD completed detailed questionnaires regarding bladder, bowel, and sexual function. In total, 45 subjects (93.8%) reported symptoms in at least one organ system (bladder, bowel, or sexual), 13 (27.1%) reported symptoms in two systems, and 19 (39.6%) reported concomitant symptoms in all three systems. Urinary problems were most frequent in 42 subjects (87.5%) followed by lower bowel (60.4%) and sexual dysfunction (56.2%). Participants reporting concomitant symptoms were more likely to have longer duration of disease and lower Total Functional Capacity (TFC) scores. This study documents the high frequency of bladder, bowel, and sexual dysfunction in HD and the common occurrence of concomitance of these pelvic organ problems.